Objective To observe the effect of blood pressure variability in patients with hypertension treated by amlodipine combined with perindopril.Methods From September 2012 to October 2013,patients with essential hypertension were given amlodipine 5 mg/d for 4 weeks,and 78 patients with blood pressure not reaching the standard after 4 weeks treatment were divided into group A and group B by random number table method,with 39 cases in each.Group A was given amlodipine 10 mg/d,and group B was given perindopril 4 mg/d on this basis (amlodipine 5 mg/d).Twenty-four hour ambulatory blood pressure was monitored in 2 groups by noninvasive portable ambulatory blood pressure monitoring in medication and 8 weeks after medication,measured values of standard deviation and coefficient of variation was used as a measurement of blood pressure variability.Results After 8 weeks of medication plus,24 h systolic blood pressure variability (24 h SSD),systolic blood pressure variability during the day (dSSD),nocturnal systolic blood pressure variability (nSSD),nocturnal systolic blood pressure variation coefficient (nSCV) and 24 h diastolic blood pressure variability(24 h DSD),diastolic blood pressure variability during the day (dDSD),nocturnal diastolic blood pressure variability (nDSD) in group A were significantly lower than those before medication plus[(13.22 ± 1.10) mmHg(1 mmHg =0.133 kPa) vs.(15.97 ± 1.65) mmHg,(12.04 ± 2.21) mmHg vs.(15.15 ±2.89) mmHg,(10.22 ±3.29) mmHg vs.(12.23 ±3.21) mmHg,0.093 ±0.021 vs.0.104 ± 0.017,(11.33 ± 2.09) mmHg vs.(13.27 ± 1.43) mmHg,(10.64 ± 1.81) mmHg vs.(12.57 ± 1.43) mmHg,(9.56 ± 1.32) mmHg vs.(11.23 ± 2.26) mmHg] (P ＜ 0.05),but there were no significant changes among 24 h systolic blood pressure variation coefficient (24 h SCV),systolic blood pressure variation coefficient during the day (dSCV) and 24 h diastolic blood pressure variation coefficient (24 h DCV),diastolic blood pressure variation coefficient during the day (dDCV),nocturnal diastolic blood pressure variation coefficient (nDCV) (P ＞ 0.05).After 8 weeks of medication plus,24 h SSD,24 h SCV,dSSD,dSCV and 24 h DSD,24 hDCV,dDSD,dDCV,nDSD in group B were significandy decreased compared with before combination plus[(10.23 ± 4.72) mmHg vs.(15.27 ± 3.23) mmHg,0.083 ± 0.032 vs.0.106 ± 0.019,(10.85 ± 3.29) mmHg vs.(15.09 ± 3.21) mmHg,0.080 ± 0.028 vs.0.096 ± 0.025,(10.13 ± 2.43) mmHg vs.(13.37 ±3.13) mmHg,0.111 ±0.035 vs.0.136 ±0.032,(9.58 ±2.49) mmHg vs.(12.29 ±3.27) mmHg,0.112 ± 0.036 vs.0.123 ± 0.04 1,(9.46 ± 2.78) mmHg vs.(11.19 ± 4.26) mmHg] (P ＜ 0.05),but there were no significant changes among nSSD,nSCV and nDCV (P ＞ 0.05).After 8 weeks of medication plus,24 h SSD,24 h SCV and 24 h DSD,24 h DCV,dSSD,dDSD,dSCV and dDCV in group B were significantly lower than those in group A (P ＜ 0.05).The nSSD,nDSD,nSCV and nDCV between 2 groups had no significant difference (P ＞ 0.05).Conclusions Amlodipine double dose or amlodipine single dose combined with perindopril can all effectively reduce the 24 hours' systolic and diastolic blood pressure variability,and the combined treatment is better and worthy of further promotion in clinic.

Objective To observe the clinical outcome of repair of the tissue defects of the tendon and skin with thigh anterolateral free flap with iliotibial tract. Methods The data was reviewed from June 2006 to June 2010, which the thigh anterolateral free flap with iliotibial tract were used to repair the defects of the tendon and skin of back of hand in 12 patients. The skin flap was 7 cm´10 cm~8 cm´12 cm in area. The iliotibial tract was 7~13 cm in length and 8~10 cm in width. Institute of Hand Surgery of Chinese Medical Association was to assess the effect. The fellow-up of the 12 patients was 6 months~4 years. Results All the flaps survived after the operation. The result showed excellent in 3 patients, good in 6 and fair in 3. Conclusion It is an effective surgical method to repair the tissue defects of the tendon and skin with thigh anterolateral free flap with iliotibial tract.

Objective To investigate the related risk factors caused the retained common bile duct (CBD)stones after laparoscopic cholecystectomy,to provide the evidence for preventing from retained common bile duct stones of laparoscopic cholecystectomy.Methods Selected 654 cases of laparoscopic cholecystectomy patients as the objects whom hospitalized in Beijing Chuiyongliu Hospital from January 2002 to June 2013.All cases were divided into the group of retained CBD stones (27cases) and the group of non-retained CBD stones (627 cases).Collected the potentially relevant factors of two groups with the retained CBD stones,including medical history of jaundice and pancreatitis,common bile duct internal diameter (B Ultrasound) ≥ 8 mm,acute cholecystitis,emergency surgery,gallbladder removal order,calot triangle adhesion,sludge calculus,stones neck incarcerated,fulltype stones,cystic duct thickening,cystic duct reserved≥ 1 cm,the minimum diameter stones ≤5 mm,the number of gallbladder stones ≥ 5,partial cholecystectomy,purulent bile.Statistics analyses was proceeded using the IBM SPSS 20.0.Result Through dichotomy logistic regression analysis to the univariate analysis results with statistical significance,sorted the results according to the influence degree,found the independent risk factors:common bile duct internal diameter (B Ultrasound) ≥8 mm,gallbladder removal order (retrograde removal),medical history of jaundice pancreatitis,cystic duct reserved ≥ 1 cm,sludge calculus,in total of 5 indexes,which caused the retained CBD stones after laparoscopic cholecystectomy.Conclusion There are several independent risk factors for retained CBD stoes after LC such as medical history of jaundice and pancreatitis,common bile duct internal diameter (B Ultrasound) ≥ 8 mm,the order of cholecystectomy (retrograde remoral),shudeg calculus and the remaining length of bile duct ≥ 1 cm.The surgeons should pay close attention to them and take appropriate measures in the preoperation and intraoperation of LC,which contribute to preventing the acurence of postoperative retaimed CBD stone.

Aim To explore the effects of Nrf2-ARE signal path on levrtiracetam anti-epileptic and levrtiracetam on learning and memorizing ability.Methods Thirty-six SD rats were divided into normal saline group, levrtiracetam group, model group and treatment group.Each group recruited nine rats.Tests of Morries water maze were given to the rats to evaluate their learning and memorizing ability.The protein expression of nuclear factor (erythroid-derived2)-like2 (Nrf2), heme oxygenase 1(HO-1) and NAD(P)H quinone oxidoreductase(NQO1) were examined by Western blot.Results Compared with model group, levrtiracetam could shorten the plateau period in epileptic rats (P<0.05), and increase the expression of Nrf2 protein, HO-1 protein and NQO1 protein in hippocampus(P<0.05).Conclusions Levrtiracetam could improve the learning and memorizing ability in epileptic rats.Levrtiracetam may increase the expression of HO-1 protein and NQO1 protein through the Nrf2-ARE pathway and play a part in antiepileptic effects.

OBJECTIVETo evaluate the feasibility of developing brain-targeted nasal delivery system of scutellarin by the passage between nase and brain in nasal olfactory area.

METHODThe samples of cerebrospinal fluid (CSF) and blood were prepared by cranial puncture and femoral artery catheterization methods respectively according to the certain sampling time after drug administered. The scuteIlarin concentration of samples were determined by 125 marked method. Pharmacokinetic parameters were calculated by trapezoidal rule. The brain-targeted trendence were evaluated by the value of the index AUC(brain)/AUC(plasma).

RESULTThe distribution of scutellarin in brain following intranasal administration was different between tissues. Drug concentration in olfactory bulb achieved to peak at 5-15 min after intranasal administration, while in brain tissue was 30-60 min. Above all, peak concentration in olfactory bulb and olfactory region respectively were (574.8 +/- 205.), (323.4 +/- 128.3) ng x g(-10, both are higher than CSF, which is (123.2 +/- 29.3) ng x g(-1). Moreover, the distribution of scutellarin given by intranasally in brain was: olfactory bulb (OB) > olfactory region (OR) > cerebrospinal fluid (CSF) > cerebellum(CB) > medulla oblongata (MO) > cerebrum (CR); AUC(0-240) of olfactory bulb, olfactory region and CSF after scutellarin intranasal administration were 5.54, 5.07 and 5.51 times of that after intravenous injection, respectively. And the AUC(0-240) of other brain tissues after intranasal administration were also higher than that after intravenous injection. AUC(brain tissue)/ AUC(plasma) of every brain tissues by intranasally are all higher than that by intravenously remarkably. For instance, 5 min after intranasal administration, the value of AUC(CSF)/ AUC(plasma), AUC(OB)/AUC(plasma), and AUC(CR)/AUC(plasma) were 30.34, 56.93, and 6.14 times of that by intravenously.

CONCLUSIONPart of scutellarin could be straightly transported into brain by the intranasal administration. Its absorption pathway was: the molecule of Scutellarin throughed olfactory mucosa in nasal cavity into olfactory bulb in arachno-hypostegal cavity, and then entered into olfactory region, CSF, cerebrum and cerebellum gradually. It showed that olfactory bulb was the only way for drug molecule to go through nasal cavity into brain. It had a significant trendence of brain-targeted when compared to oral administration and intravenous injection, which indicated a certain feasibility to develop a brain-targeted nasal delivery system for scutellarin.

Administration, Intranasal ; Animals ; Apigenin ; administration & dosage ; pharmacokinetics ; Brain ; drug effects ; metabolism ; Drug Delivery Systems ; methods ; Glucuronates ; administration & dosage ; pharmacokinetics ; Male ; Rats ; Rats, Sprague-Dawley

Objective To investigate the security and efficacy of one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by uniportal-video-assisted thoracic surgery(VATS) to cure patients with myasthenia gravis(MG).Methods A number of 131 patients with MG who underwent resection of thymic tissue and clearance of mediastinal fat by VATS in one single center from February 2009 to December 2013 were selected in this retrospective study.76 patients underwent unilateral resection of thymic tissue and clearance of mediastinal fat by three portal VATS from February 2009 to March 2012 and 55 patients underwent one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS from April 2012 to December 2013.The time for operation,the bleeding volume during operation,the volume of postoperative drainage and drainage time,the improvement of symptoms,the postoperative pain,hospital stays and the occurrence of myasthenia gravis crisis were compared between the two groups.Results The general condition and pathological type did not have significant statistical differences between the two groups.The operating time in the uniportal-VATS group was significantly longer than that in three portal VATS group,but the pain was lighter,and the hospital stay was shorter.There were no significant differences between groups in terms of blood loss,postoperative drainage time,and volume of drainage.The follow-up was from 32 to 90 months,and 118 (90.08％)patients completed the follow up.94.5 ％ of the patients in uniportalVATS group acquired complete stable remission(CSR),while it was 84.2％ in three portal VATS group(P ＜ 0.05),and the uniportal-VATS group had lower rate of myasthenic crisis (P ＜0.05).Conclusion One stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS is safe and effective with shorter hospital stay and less pain,and it can get higher CSR and less myasthenic crisis,its efficacy is superior to traditional three portal VATS.

Objective To explore the serum levels of VILIP-1 and Cav-1 in cases with severe craniocerebral injury undergoing decompression and their effects on the prognosis.Methods 108 patients with severe craniocerebral injury who were treated in our hospital from July 2019 to July 2022 were selected as the study group,and 120 healthy people who came to our hospital for physical examination were selected as the health group.All cases were followed up for 6 months,and were divided into good prognosis group(GOS=4-5 points,n=82)and poor prognosis group(GOS=1-3 points,n=26)according to GOS.The levels of serum VILIP-1 and Cav-1 were detected by ELISA.The diagnostic value of serum VILIP-1 and Cav-1 on the prognosis of patients was evaluated by the ROC curve.Multivariate logistic regression analysis was used to explore the prognostic factors of patients.Results The levels of serum VILIP-1 and Cav-1 in study group were higher than those in healthy group(P＜0.05).The levels of serum VILIP-1 and Cav-1 in case with poor prognosis were higher than those in cases with good prognosis(P＜0.05).The AUC(95％CI)of serum VILIP-1 and Cav-1 to predict the prognosis of patients was 0.848(0.797～0.899)and 0.817(0.766～0.868).The AUC(95％CI)of the combined detection was 0.905(0.854～0.956).The time from injury to admission,admission GCS score,history of diabetes,admission pupillary reaction,preoperative brain midline displacement and postoperative complications in good prognosis group were different from those in poor prognosis group(P＜0.05).Preoperative midline displacement≥5 mm(OR=2.467,95％CI:1.619～3.760),postoperative complications≥ 2(OR=2.321,95％CI:1.544～3.489),VILIP-1≥10.37 ng/ml(OR=3.367,95％CI:2.087～5.432),and Cav-1≥32.28 μg/L(OR=2.770,95％CI:1.786～4.298)were risk factors for prognosis in patients(P＜0.05).Conclusion Serum VILIP-1 and Cav-1 can be used as biological indicators to predict the prognosis of patients with severe brain injury after decompression,and the increase of serum VILIP-1 and Cav-1 levels are risk factors for prognosis.

Objective:To investigate the application of Folly urethral catheter in transvastatal resection of adhesion (TCRA) and its preventive effect on prevention of re-adhesion.Methods:A total of 78 patients with intrauterine adhesions admitted to the Department of gynecology and obstetrics of the Maternal and Child Health Care Hospital Affiliated to Anhui Medical University from March 2018 to March 2019 were selected as the study objects.The prospective study was conducted and divided into two groups according to the computer random number method.In the control group, 39 cases were treated by TCRA combined with intrauterine placement of contraceptive ring, while in the observation group, 39 cases were treated by hysteroscopic adhesion separation operation combined with Folly catheter placement.The curative effect, intrauterine adhesions, menstrual improvement score, recurrence and pregnancy were compared before and 6 months after operation.Results:The total effective rate of the observation group was 94.87% (37/39), and that of the control group was 79.49% (31/39), The difference between the two groups was statistically significant (χ 2=4.129, P<0.05). The score of intrauterine adhesions was (22.14±2.57) in the control group and (1.76±0.87) in the observation group, and (23.05±3.08), (1.81±0.60) in the observation group, there was no significant difference between the two groups( t=1.417, 0.295; all P>0.05). At 3 months after operation, the scores of intrauterine adhesions and menstrual states in the control group were (17.63±2.88) and (1.07±0.38), respectively, and those in the observation group were (14.27±3.52) and (0.53±0.21), the difference between the two groups was statistically significant( t=4.614, 7.767, all P<0.001). There were significant differences in the scores of intrauterine adhesions and menstrual state before and after operation in the observation group ( t=7.297, 4.539, all P<0.001). There were significant differences in the scores of intrauterine adhesions and menstrual states before and after operation in the observation group ( t=11.723, 12.575, all P<0.001). The recurrence rate was 23.08% (9/39) in the observation group and 46.15% (18/39) in the control group at 6 months after operation.The difference was statistically significant ( P=0.032). The pregnancy rate of the observation group was observed.12.82% (5/39), 7.69% (3/39) in the control group, the difference was not statistically significant( P=0.455). Conclusion:Hysteroscopic adhesion separation combined with Folly catheter placement for the treatment of intrauterine adhesions can significantly improve the short-term efficacy, prevent re-adhesion, and better regulate the menstrual cycle.

Objective    To investigate the effectiveness of sublobar resection and lobectomy via uniportal video-assisted thoracoscopic surgery (U-VATS) for lung metastases from colorectal cancer. Methods    Retrospective research was conducted on 42 colorectal cancer patients with lung metastases who underwent U-VATS sublobar resection and lobectomy at the Tongji Hospital, Huazhong University of Science and Technology between April 2016 and May 2019, including 24 males and 18 females with an average age of 58.0±9.9 years. Among them 17 patients received U-VATS sublobar resection and 25 patients received lobectomy. The operation time, intraoperative blood loss, postoperative pulmonary infection, drainage tube indwelling time, drainage volume on the first day after surgery, postoperative hospital stay were analyzed between the two groups, and the relationship between the prognosis and clinical characteristics of the two groups was compared. Results    Sublobar resection patients had less lung metastases (P=0.043) and shorter operation time (P=0.023) compared with the lobectomy patients. There was no significant difference between the lobectomy and sublobar resection groups in intraoperative blood loss (P=0.169), rate of postoperative infection (P=0.982), postoperative drainage duration (P=0.265), drainage volume on the first day after surgery (P=0.402) and postoperative hospital stay (P=0.612). The progression-free survival of the two groups was 25.19 months and 23.63 months (P=0.721), and their overall survival was 29.09 months and 30.64 months (P=0.554). Conclusion    Considering guantity and locations of lung metastases, U-VATS sublobar resection can achieve a similar prognosis to lobectomy for lung metastases from colorectal cancer. Further efficacy of this surgical strategy remains to be proved by longer follow-up.

Objective:To understand the degree of professional autonomy of nurses in Pediatric Nursing Alliance and the status of pediatric nursing practice environment, which providing guidance for the development of a series of specialized training in the alliance.Methods:Stratified random sampling method was used to conduct a questionnaire survey on nursing staff of different professional levels in Pediatric Nursing Alliance, which through the questionnaire star by using the questionnaire general information and training demand questionnaire, nurses practice professional autonomy scale, pediatric nursing staff structural empowerment questionnaire and nursing practice influencing factors questionnaire through the questionnaire star.Results:The total score for professional autonomy of nurses in the pediatric alliance was 192.66±18.63, the structural empowerment ( OR=1.137, 95% CI=1.084-1.194), lack of caring team ( OR=2.763, 95% CI=1.443-5.292) and performance evaluation ( OR=0.498, 95% CI= 0.274-0.908), specialized education and professional experience ( OR=0.548, 95% CI= 0.334-0.871) were affecting the clinical nursing practice. Conclusion:The degree of professional autonomy of nurses in the Pediatric Nursing Alliance is in the middle and high level. Key factors affecting nursing practice including insufficient structural empowerment, lack of opportunities to continue learning, lack of nursing teams, lack of effectiveness evaluation and the lack of specialized education and work experience, which guiding the pediatric nursing alliance to continuously deepen the connotation of pediatric nursing professional and innovative team collaboration new model, utilize the advantages of resources to actively cultivate specialized nursing research personnel, carry out multi-disciplinary and cross-disciplinary cooperation, improve the nursing quality evaluation index system, so as to enhance the professional nursing service capacity and value.