BACKGROUND:Oral insulin iS easy to be degradated by hydrochloric acid in gastric iuice and the enzyme which exists in stomach and intestines,while it is dimcult to through the epithelium cell membrane of gastrointestinal.Even a lasting-long injection iS taken,and it still needs an injection once 36 hours.OBJECTIVE:To prepare oraI insulin sustained-release microspheres.DESIGN,TIME AND SETTING:Contrast observation which was carried out at the Laboratory of Medical Chemistry of Nanjing Information Engineering University from September 2003 to December 2004.MATERIALS:Insulin Was provided bv Nanjing Medicinal Factory of Bio-Chemistry.METHODS:A new method tO prepare the microsphere,I.e.,drying through liquid phase was adopted with the special pH and the acrylic acid polymer which could be dissolved as the medicine'S carrier of the sustained-release microphere.MAIN 0UTCOME MEASURES:The effects of polymer concentration and agitation rates on size of microspheres and drug incorporation efficiency were studied by scanning electronic microscopy(SEM)and ultraviolet-spectrophotometry.RESULTS:The temperature,drug payloads and the content of emulsifier played important effects on microspheres formation.The mean diameter of microspheres decreased with increasing in stirring rate and decreasing in polymer concentration,and drug loading efficiency increased with increasing in stirring rate.CONCLUSION:Insulin-loaded polyacrylate sustained-release microspheres is prepared preferably.

Objective To explore the effect of continuous subglottic irrigation and aspiration in patients with artificial airway. Methods One hundred and twenty-eight patients with mechanical ventilation were randomly divided into observation group and control group with 64 cases in each group.The observation group was treated by continuous subglottic irrigation and aspiration,and the control group received traditional nursing.The two groups were observed and compared in terms of incidence of aspiration and ventilator-associated pneumonia.Result The incidences of ventilator associated pneumonia(VAP)and aspiration in the observation group were significantly lower than that in the control group(P<0.05).Conclusion Continuous subglottic irrigation and aspiration can effectively prevent aspiration and VAP among patients with artificial airway.

BACKGROUND:Insulin taken orally is easy to be degraded by hydrochloric acid in the gastric juice and various enzymes in the gastrointestinal tract.It is hard for oral insulin to pass through the epithelial cell membrane in the gastrointestinal tract.Insulin delivered by injection needs at least 36 hours every administration.Many pulmonary administrations of insulin have been recentl studied,such as dry powder inhalation,aerosol inhalation,electron spraying,insulin nanometer technique,and absorption enhancer,with promising clinical application prospects.OBJECTIVE:To investigate the glucose-lowering effects of insulin delivered by oral inhalation in normal rats.METHODS:Thirty healthy male rats,weighing (220±30) g were randomly divided into seven groups:low dose insulin (1.0 U/kg,n=4),middle dose insulin (5.0 U/kg,n=4),high dose insulin (10,0 U/kg,n=4),insulin (2.0 U/kg) +5% lecithin (n=5),insulin (2.0 U/kg)+1% oleic acid (n=5),insulin (2.0 U/kg) +1% diethylenetriaminepentaacetic acid (DTPA; n=5),and blank control (n=3).At 0,30,60,120,180,240 minutes after administration.1.5μL blood was taken from rat tails through the use of ONE TOUCH~(TM) BASICTM PLUS blood glucose detection system for determination of blood glucose level and calculation of insulin pharmacological bioavailability under various conditions.RESULTS AND CONCLUSION:Insulin (1U/kg) markedly decreased glucose levels immediately after inhalation.Blood glucose level decreased with increasing insulin dose.Insulin (10 U/kg) could produce a 14.5% decrease of blood glucose level.Insulin (1 U/kg) could yield a pharmacological bioavailability of 11.5% in the absence of absorption enhancer.The concomitant administration of oleic acid,DTPA and lecithin appeared to be more effective in enhancing the pulmonary absorption of insulin,and decreasing blood glucose level.

ve To compare the effects of coronary-artery-bypass (CAB) surgery with and without cardiopulmonary bypass(CPB) on hemodynamics and the function of the grafts. Methods Thirty-five patients undergoing elective CAB surgery were studied. CAB was performed either with hypothermic CPB (n = 15) or without CPB(off-pump, n = 20) . The patients were premedicated with intramuscular pethidine 50 mg and scopolamine O.3mg. Anesthesia was induced with intravenous midazolam 5-15mg, fentanyl 5-20?g?kg and pancuronium 0.1 mg?kg-1 or pipecuronium 0.1 mg?kg-1 and maintained with iv infusion of fentanyl 6-10?g?kg-1, propofol 2-4mg?kg-1?h-1 and intermittent boluses of pancuronium, midazolam supplemented with 1%-1.5% isoflurane inhalation. In off-pump group naso-pharyngeal T?was maintained at 37.2℃ during operation. The amount of heparin used was equal to about one-third of amount used during CPB and ACT was maintained above 250 seconds. MAP was maintained at 70-90 mm Hg. While blood vessel was being grafted onto the coronary arteries heart rate was maintained at 60-80 bpm, otherwise esmolol 10-20mg was given iv every 5 min until it was satisfactorily controlled. In CPB group, during CPB naso-pharyngeal T?was maintained at 32℃-34℃, MAP at 50-70 mm Hg and blood gases and electrolytes within normal range. Right radial artery was cannulated and 7.5F Swan-Ganz catheter was inserted via internal jugular vein into pulmonary artery for hemodynamic monitoring and blood gas analysis. ECG, SpO2 were continuously monitored during operation. At the end of operation in patients with internal mammary artery used as graft, the flow rate of grafts was measured with 3mm Doppler probe.Results (1) After CAB cardiac index (CT) increased significantly in off-pump group(P0.05) . (3) There was no significant difference in the blood flow of artery graft and myocardial oxygen delivery (MDO2), and consumption ( MVO2) as well as MDO2/MVO2 between the two groups. Conclusions Off-pump CAB surgery has less effects on hemodynamics but systemic and myocardial oxygen delivery and consumption are similar between the two groups.

ObjectiveTo investigate the effects of electroacupuncture in Guanyuan(Ren4) and Zhongji(Ren3) on the functions of neurogenic bladder in patients with spinal cord injury(SCI) with the standard urodynamic measure.Methods15 patients with neurogenic bladder after SCI were included into the study.During urodynamic measure,they accepted electroacupuncture in Guanyuan(Ren4) and Zhongji(Ren3).The changes of the bladder storage volume(VH2O),bladder pressure(Pves),detrusor pressure(Pdet) and bladder compliance(BC) before and after electroacupuncture were recorded.ResultsThe patients' VH2O increased from(124.00±77.37) ml to(144.47±85.87) ml(P<0.01),Pves decreased from(65.33±23.90) cmH2O to(55.27±17.52) cmH2O(P<0.05),Pdet decreased from(52.87±18.68) cmH2O to(44.93±15.82) cmH2O(P<0.05)and BC increased from(2.35±2.05) ml/cmH2O to(3.48±3.04) ml/cmH2O(P<0.01).ConclusionElectroacupuncture is effective on neurogenic bladder recovery in patients with SCI.

Objective To study the effects of Traditional Chinese Medicine(TCM)therapy on shoulder hand syndrome(SHS).Methods 50 patients with SHS were divided into rehabilitation group and control group.The patients in rehabilitation group accepted physiotherapy and TCM therapy,which include marinate in traditional herb,pulsed electromagnetic therapy,massage and stimulate point.The patients in control group accepted physiotherapy only.They were evaluated after 1 month.Results The cured rate and the improved rate in rehabilitation group were higher than those in control group(P<0.05).Conclusion The TCM therapy is effective on SHS.

ObjectiveTo observe the effect of Compound Anisodine Injection in the acupoint of the patients with cerebral infarction (CI) at recovery stage. Methods54 patients with CI at recovery stage were injected Compound Anisodine Injection into the acupoint Taiyang. They were assessed with the Ashworth Scales 0.5, 1, 2, 4, 8 h after injection. ResultsThe scores of Ashworth scale in affected sides reduced first and then reconverted after injection, but no changes in the health side. ConclusionThe Compound Anisodine Injection injecting into the acupoint Taiyang can reduce the muscular tension of paralytic limbs of patients with CI stroke at recovery stage.

Chinese Medical therapy such as herbal treatment, acupuncture were used in rehabilitaion for spinal cord injury and proved effective. It is important to explore the advantage and disadvantage of them.

BACKGROUND:Autologous peripheral blood hemopoietic stem cell transplantation(HSCT)in combination with high-dose chemotherapy significantly improves complete remission and survival rate of multiple myeloma patients.However,the relapse rate is high.Bortezomib is 26S proteasomes inhibitor,and effective on the primary treatment of multiple myeloma.OBJECTIVE:To evaluate the curative effect of HSCT in combination with bortezomib and high dose-melphalan for multiple myeloma.METHODS:A retrospective analysis of 3 patients with a stage-ITT multiple myeloma admitted to Department of Hematology,Affiliated Hospital of Guiyang Medical College from October 2006 to May 2007,was conducted.Chemotherapy and granulocyte colony-stimulating factor were used to mobilize autologous peripheral blood hemopoietic stem cells.All patients were pretreated with 200 mg/m2 melphalan via intravenous drip 3 days before transplantation,followed by HSCT 48 hours after drug termination.RESULTS AND CONCLUSION:All patients obtained prompt and sustained hematopoietic reconstitution,and bone marrow depression restored 30 days following HSCT.Case 1 and 2 obtained complete remission,and case 3 obtained partial remission.Results show that HSCT in combination with bortezomib and high-dose melphalan is a safe and feasible treatment on multiple myeloma.The patients have good tolerance to pretreatment.

BACKGROUND: Rituximab single or in combination with CHOP regimen for treatment of CD20-positive non-Hodgkin lymphoma has achieved good curative effects. Autologous hematopoietic stem cell transplantation (AHSCT) has been shown to improve the curative effects and increase survival rate of patients with non-Hodgkin lymphoma. However, the curative effects of these two methods remain disputed. OBJECTIVE: To investigate the efficiency of rituximab in combination with AHSCT on CD 20-positive non-Hodgkin lymphoma. METHODS: Six patients with CD 20-positive non-Hodgkin lymphoma (stage IV) underwent AHSCT and rituximab administration. 375 mg/m~2 rituximab was intravenously administered 2-4 times prior to AHSCT, twice prior to and after peripheral blood stem cells mobilization and preprocessing, respectively, as well as once every 3 months after AHSCT. RESULTS AND CONCLUSION: The mean number of mononuclear cells and CD 34-positive cells was 5.13×10~(-8)/kg and 4.75×10~(-6)/kg, respectively. Following AHSCT, all 6 patients presented normal hematopoietic functions, neutrophils exceeded 0.5×10~(-9)/L at 9-15 days and blood platelet counts exceeded 20×10~(-9)/L at 12-19 days. Hemorrhagic cystitis, interstitial pneumonia, cytomegalovirus infection, or hepatic venous obstruction was not observed during the whole process of AHSCT in each patient. At 6-32 months, patients completely recovered. These results indicate that rituximab in combination with AHSCT is a good method for treatment of CD20-positive non-Hodgkin lymphoma and rituximab maintenance therapy could prevent disease recurrence.