Objective To observe the effect and adverse reaction of fentanyl ransdermal system on the cancer pain resulted from lung cancer metastasizing to bone.Methods Thirty -two patients with moderate to severe cancer pain of bone metastasis from lung cancer were treated with fentanyl transdermal system.Analgesic effect was observed.The quality of life and adverse reactions were evaluated.Results The PI evaluation were (7.62 ± 1.35)and (1.93 ±2.41)before /after treated with fentanyl ransdermal system.The differences of bone pain between before and after treated were significant(t =3.983,P <0.01).Among the thirty -two patients with moderate to severe cancer pain used by fentanyl transdermal system,complete relief was in 12 cases(37.5%),apparent relief was in 11 cases(34.3%),moderate relief was in 7 cases(21.8%),mild relief was in 2 cases(6.3%),the total relief rate was 93.7%.The adverse reactions included hypersomnia were in 13 cases,dizziness in 11 cases,nausea and vomiting in 6 cases,constipation in 5 cases,pruritus and erythra in 4 cases,dysuria in 2 cases.All above adverse reactions dis-appeared after stopping fentanyl ransdermal system and /or undergoing symptomatic treatment.Conclusion Fentanyl transdermal system is easy to use,the effect is significant,there is few adverse reactions,which can significantly improve quality of life of cancer patients.

Purpose: To observe the efficacy of intraperitoneal chemotherapy on advanced gastric cancer after radical treatment. Methods: 64 cases of patients with stage Ⅱ - Ⅲ treated by radical surgery were selected and randomly divided into systematic plus intraperitoneal chemotherapy group and systemic chemotherapy group. 3-year survival rate and 3-year recurrence rate were recorded. Results: The recurrence rate for the intraperitoneal chemotherapy group was 18.75% while the control was 43. 33% (P

Objective To explore the correlation of anxiety and depression with social support among caregivers of children with mental retardation and major related influencing factors.Methods 64 mothers of children with mental retardation were investigated by using the questionnaires of SAS,SDS and SSRS.The results underwent analysis.Results The incidence of anxiety among mothers of children with mental retardation was 23.4％,the incidence of depression was 40.7％.Mothers had higher scores of SAS and SDS than the national norm.The total score of social support was(32.19±5.02),which was lower than the national norm.The anxiety and depression was negatively correlated with social support.The influencing factors of anxiety and depression of mothers were family income.Conclusions The anxiety and depression among mothers of children with mental retardation was evident,the social supports for those mothers were insufficient.Effective social support was propitious to abate the anxiety and depression and promote quality of life of those children with mental retardation and their mothers.

Human errors are errors found in planning or implementation, and those found in medical practice are often major causes of mishaps.To name a few, wrong-site surgery, medication error, wrong treatment, and inadvertent equipment operation.Errors of this category can be prevented by learning from experiences and achievement worldwide.Preventive measures include those taken in human aspect and system aspect, reinforced education and training, process optimization, and hardware redesign.These measures can be aided by multiple safety steps in risky technical operations, in an effort to break the accident chain.For example, pre-operative surgical site marking, multi-department co-operated patient identification, bar-coded medication delivery, read-back during verbal communication, and observation of clinical pathway.Continuous quality improvement may be achieved when both the management and staff see medical errors in the correct sense, and frontline staff are willing to report their errors.

Objective To explore the teaching effects of Lecture Based Learning (LBL) incorporated with Case Based Learning (CBL) and Problem Based Learning (PBL) methods in the teach-ing of anatomy.Methods 740 students of Grades 2012 and 2013 from clinical medical major were chosen as the subjects,randomly divided into experimental and control groups.LBL was conducted in the control group of 644 students,while LBL+PBL+CBL method was applied in the experimental group of 96 students.After completion of the course,all students were surveyed with the questionnaire and tested with specimen and theoretical examinations.The data was collected and analyzed with SPSS 17.0 and two sample U tests.Results The students' time of learning anatomy in the control group outside classroom teaching was (105 ± 25) minutes per week,while the students' time of learning anatomy in the experimental group was (190 ± 25) minutes per week.The difference was statistically significant (t=31.08,P=0.000).The difference of after-class total learn-ing time was also statistically significant between two groups(t=27.42,P=0.000).Percentages of satisfaction with teaching methods for control group were 87.5％ and 87％,while for the experimental group 98％ and 100％.Kruskal-Wallis test showed there were significant differences in experimental groups of grades 2012(x2=31.19,P=0.000) and 2013 (x2=40.35,P=0.000) compared with control group.Comparison of both groups' results of the examinations was statistically significant concerning multiple choices,essays and case analysis questions (P＜0.05).Conclusion Teaching method of LBL incorporated with PBL and CBL was significantly effective than that of the sole traditional LBL method,which indicated its practice value.

Objective To evaluate the efficacy and safety of recombinant human brain natriuretic peptide (rh-BNP) combined with levosimendan on acute myocardial infarction complicated by heart failure.Methods Patients who suffered from anterior wall acute myocardial infarction (AMI) with heart failure (KillipⅡ ～ Ⅲ) within 12 to 24 hours after the onset of chest pain were randomized into two groups: the control group (n=30, receiving dobutamine and/or cedilanid) and the experimental group (n=30, receiving rh-BNP combined with levosimendan).The hemodynamics, parameters of laboratory tests and adverse events were observed before and after treatment.Results The experimental group showed that the respiratory rate (RR), heart rate (HR), systolic blood pressure (SBP), arterial blood gas oxygen saturation (SaO2), cardiac index (CI), extravascular lung water index (EVLWI) were significantly different between 2 h and sequential time points after treatment and pre-treatment (allP＜0.05).The control group showed that RR, HR, SaO2, CI, EVLWI were significantly different between 6 h and sequential time points after treatment and pre-treatment (P＜0.05 for all).There were significant differences in RR, HR, SBP, SaO2, CI, EVLWI at 2 h and 6 h after treatment between the two groups (P＜0.05 for all).Parameters of RR, HR, CI, EVLWI at 72 h after treatment had differences between the experimental group and controls.Patients in the experimental group presented larger urine volume, lower level of plasma NT-pro BNP, higher left ventricular ejection fraction (LVEF) and shorter length of stay in CCU as compared with patients in the control group (P＜0.05 for all).In adverse events monitoring in hepatic parameters, electrolyte level and coagulation function before and after treatment, there was no significant difference between the two groups.Conclusions Compared with the conventional treatment, the combination therapy with rh-BNP and levosimendon can improve the hemodynamics, increase the urine volume, decrease the level of plasma NT-proBNP and elevate LVEF significantly, so as to improve the clinical symptoms and shorten the hospital stay in patients with acute myocardial infarction complicated by heart failure.

OBJECTIVE:To study the effect of quercetin on the proliferation and apoptosis of human gastric carcinoma cell line MGC-803.METHODS:MTT assay was adopted to measure the effect of quercetin at different concentrations on the proliferation of MGC-803 cells.Cell apoptosis index(AI)induced by quercetin was measured by TUNEL assay.RESULTS: Quercetin at a certain concentration from 40?mol/L to 100?mol/L could successfully inhibit the proliferation of MGC-803 cells in a dose-dependent manner.TUNEL assay indicated that apoptosis cells induced by quercetin in treatment group were much more than that in control group after 48 hours(P

Objective: To investigate the application of therapeutic communication in patients with foreign body in digestive endos?copy. Methods: A total of 31 patients with foreign body undergoing endoscopic treatment from Jun 2014 to Feb 2015 were selected as control group and received conventional education. A total of 31 patients with foreign body undergoing endoscopic treatment from Mar 2015 to Oct 2015 were selected as observation group and received therapeutic communication. The number of mind state, nursing sat?isfaction and adverse events were analyzed. Result: There was significant difference in the number of mind state, nursing satisfaction and adverse events in 2 groups. Conclusion: Therapeutic communication can help to resolve the patient?s sense of fear, improve the mind state, active cooperation, reduce operation risk and adverse events, ensure the treatment effect, improve nursing satisfaction.

Clopidogrel was believed to be superior to aspirin by the well-known CAPRIE trial. However, no other large clinical trials demonstrated the same results, but all focused on the combination use of clopidogrel with aspirin, and combination therapy in CREDO was called the "Emperor's New Clothes". However, no one overturned the results of these clinical trials by quantitatively analyzing them. We reviewed ten large-scale clinical trials about clopidogrel. On the basis of results of CAPRIE, CREDO and CHARISMA trials, we re-estimated their minimal sample sizes and their powers by three well-established statistical methodologies. From the results of CAPRIE, we inferred that the minimal sample size should be 85 086 or 84 968 but its power was only 30.70%. A huge gap existed. The same was also true of CREDO and CHARISMA trials. Moreover, in CAPRIE trial, 0 was included in the 95% confidence interval and 1 was included in the 95% confidence interval for the relative risk. There were some paradoxical data in CAPRIE trial. We are led to conclude that the results in CAPRIE, CREDO, and from the subgroup analysis in CHARISMA trials were questionable. These results failed to demonstrate that clopidogrel was superior to aspirin or that clopidogrel used in combination with aspirin was better than aspirin alone. The cost-effectiveness analyses by some previous studies were not reliable.

Objective:To evaluate the clinical efficacy and safety of using the F4.8 Visual Puncture Micro-percutaneous nephrolithotomy to treat the female distal calculi associated with stricture.Methods:From June 2017 to December 2019, 32 female patients with distal ureteric calculi associated with stricture, aged(35.0±10.3) years ( range from 16 to 75 years)old, were enrolled into this retrospective study. They were diagnosed by colour doppler ultrasound, IVU(intravenous Urography), or CT, et al. The average stone size was (13.0±3.6)mm in diameter(range from 3 to 20 mm), and the stone obstruction duration was from 2 to 35 days, with average of(5±17) days. Twenty-seven cases were on the unilateral ureter and 5 cases were on the bilateral ureters. There were 17 cases undergoing ESWL 2 weeks before. Six cases of stone diameter less than 6 mm were administered medical therapy for more than 7 days. All the 32 case underwent ureteroscopic lithotripsy but failed because of the ureter stricture. They all suffered from hydronephrosis, with the diameter of renal collecting system from 15 to 45 mm, with(23±15)mm on average. The lithotomy position was taken, and the F4.8 Visual Micro-percutaneous nephrolithotomy using 0.9% Sodium chloride was applied to enter into ureter through urethra. There were 21 cases of ureter orifice stricture, including 8 cases associated with avulsion or perforation, 9 cases associated with intramural ureter abnormality and stricture, the zebra guidewire being failed to enter. The F4.8 Visual Micro-percutaneous nephrolithotomy cooperated with water pressure modulation was used to flush and open the ureter orifice and intramural ureter for entering. Holmium lase was used for lithotripsy. Two cases stone were infective and obstructed seriously. F4.8 Visual Micro-percutaneous nephrolithotriptor entered the ureter and destroyed the stones, and the stone fragments were discharged. Stone migrated upward and escaped occurred in 1 case, then the zebra guidewire was indwelled and ureteroscope was used for lithotripsy successfully. All cases were indewelled F4.7 doubld-J tube and urethral catheter after operation.Result:All the 32 patients underwent lithotripsy successful by one-stage. The operation time was 15-43 min [averaged (35.0±8.7)min]. All patients were recovered and discharged 4-7(averaged 5.3) days after operation. Three patients occured fever, T>38.5℃, and they recovered by using sensitive antibiotics according to the blood and urine culture. No severe complications occurred, such as ureteral perforation or extravasation. All patients were reviewed by ultrasound and KUB 3 days after operation, finding 24 cases with stone free, and 8 cases of a little residual stone, with the stone free rate of 75%. One month later, ultrasound and IVU was performed, and no residual stone was detected, with the stone free rate of 100%. The hydronephrosis alleviated by varying degrees. The diameter of the renal collecting system was from 0 to 35 mm, with(12±9)mm on average. The IVU showed the ureter was unobstructed. Conclusions:The F4.8 Visual Micro-percutaneous nephrolithotomy is safe and effective for the female distal calculi associated with stricture, when routine ureteroscopic lithotripsy failed.