Objective To observe the influence of low epidural anesthesia on heart rate variability (HRV) and blood pressure,heart rate in elderly hypertensive patients.Methods 125 patients who were adopted routine selective pelvic cavity operation or lower limb operation were divided into the two groups,the observation group(56 cases) complicate with hypertension,control group (69 cases)with normal blood pressure.The heart rate,blood pressure and low frequency,high frequency of HRV before and 5min,15min,45min after anesthesia were monitored and compared.Results Before operation and 5,15,45 min after anesthesia,the systolic blood pressure were (150.2 ±12.4)mmHg,(142.6 ±12.9)mmHg,(127.6 ±12.9)mmHg,(123.7 ±11.3)mmHg,diastolic blood pressure were(84.2 ±12.3)mmHg,(75.3 ±10.4)mmHg,(73.7 ±8.61)mmHg,(71.7 ±7.3)mmHg,heart rates were (88.4 ±11.3)times/min,(82.3 ±9.1)times/min,(78.4 ±10.5)times/min,(77.5 ±10.5)times/min,low frequency ofHRV were (87.5 ±23.7)Hz,(76.4 ±22.2)Hz,(55.4 ±22.1)Hz,(62.4 ±21.3)Hz,high frequency of HRV were(50.2 ±22.2)Hz,(32.3 ±16.7)Hz,(29.5 ±18.3)Hz,(26.3 ±18.4)Hz in the observation group;The systolicblood pressure were (133.6 ±11.4)mmHg,(123.1 ±9.5)mmHg,(121.6 ±10.1)mmHg,(120.3 ±16.3)mmHg,diastolic blood pressure were (77.3 ±11.8)mmHg,(71.4 ±10.5)mmHg,(70.4 ±10.2)mmHg,(71.2 ±8.6)mmHg,heart rate were (85.8 ±10.7 )times/min,(85.8 ±10.7 )times/min,(84.3 ±11.4)times/min,(84.5 ±11.9)times/min,low frequency of HRV were (69.1 ±20.7)Hz,(59.6 ±22.1)Hz,(45.7 ±26.8)Hz,(56.3 ±17.4)Hz,high frequency of HRV were (39.5 ±20.3)Hz,(34.6 ±18.9)Hz,(40.6 ±21.7)Hz,(41.1 ±18.1)Hzin the control group;The systolic blood pressure and diastolic blood pressure in the observation group after anesthesiawere lower than those before operation(systolic blood pressure:t =4.622,5.361,5.732,all P <0.05;diastolic bloodpressure:t =4.778,5.246,5.835,all P <0.05),The systolic blood pressure and diastolic blood pressure in the control group after anesthesia were lower than those before operation(systolic blood pressure:t =3.135,3.526,3.778,allP <0.05;diastolic blood pressure:t =3.636,3.578,3.467,all P <0.05),The systolic blood pressure and diastolicblood pressure in the observation group declined by a larger margin than those in the control group(t =3.782,3.825,3.562,all P <0.05),the heart rate after anesthesia were lower than those before operation both groups(observationgroup:t =4.613,5.724,6.146,all P <0.05;control group:t =3.143,3.672,3.572,all P <0.05),the heart rate inthe observation group declined by a larger margin than those in the control group(t =3.052,3.462,3.782,all P <0.05),low frequency of HRV and high frequency of HRV in the observation group after anesthesia were lower thanthose before operation(low frequency of HRV:t =4.144,5.156,4.714,all P <0.05;high frequency of HRV:t =4.614,4.352,4.667,all P <0.05),low frequency of HRV and high frequency of HRV in the control group after anesthesia were lower than those before operation(low frequency of HRV:t =2.625,3.622,3.725,all P <0.05;highfrequency of HRV:t =3.273,3.605,3.726,all P <0.05),low frequency of HRV and high frequency of HRV in theobservation group declined by a larger margin than those in the control group(low frequency of HRV:t =3.578,3.061,3.136,all P <0.05;high frequency of HRV:t =3.851,3.414,3.684,all P <0.05).Conclusion Low epidural anesthesia would exert huge impact to the autonomic nervous system of elderly hypertensive patients.

This paper evaluates the quality of clinical literature on cupping therapy,analyzes the key factors that influencing the effects of cupping therapy,studies the operation position,tools,accompanied therapy,cupping,cupping frequency,course and other factors in the clinical application of cupping therapy,aiming to provide reference for clinical practice.

Objective To explore the outpatients′experience of caring and provide references for improving their experience of medical care.Methods The phenomenology research method was adopted in this study,and twenty-one outpatients were subject to an in-depth interview to learn their outpatient experiences.Results Ten themes of experience with caring were extracted as follows:passionate and patient,careful and considerate,respect for others,offers to help,encouraging and comforting,apologies and courteously,humor,truthful considerations,conscientious and responsible,and a caring environment setup.Five themes of experience without caring were extracted as follows:impatient communication, careless seeing of outpatients,delayed service,passive reminders,and facilities without enough details. Conclusions The outpatients may have abundant experiences of caring at the outpatient clinic,also lack of caring sometimes as well.Outpatient managers should keep an eye on outpatients′needs and satisfaction of caring from time to time,to improve the quality of outpatient service.

Background Fungal keratitis is one of primary infectious ocular diseases in China.Conventional diagnostic method is fungal cultivation.In vivo laser confocal microscope is a noninvasive examination of ocular surface.However,the study on features of in vivo laser confocal microscope images of frequent fungal keratitis is still not thorough.Objective This study was to analyze laser confocal microscope imaging features of four typical fungal keratitis.Methods The clinical data of 65 eyes from 65 patients with fungal keratitis were retrospectively analyzed.The patients were initially diagnosed in Nanjing General Hospital of Nanjing Military Command PLA from January 2007 to November 2011, and laser confocal microscope examination of ocular surface and fungal cultivation were performed.The characteristics of laser confocal microscope images were investigated,including shape and type of hypha,distribution of spores and the relationship of hypha with lesion.The differentiation between fungal hypha and other corneal tissues was summarized.Results Fungal cultivation showed that among the 65 patients,Fusarium,Aspergillus,Candida and Alternaria were common pathogenic fungus with the infected proportion 63.0％ , 16.9％,3.0％ and 4.6％ ,respectively, and 12.5％ patients were infected by other fungus.In the images of laser confocal microscope,hyphae of Fusarium presented the branch-like high reflective structure in the corneal superficial stromal layer and thinning line shape in the deep stromal layer.Few inflammatory cells were found.The peudohyphae and spores from Candida were seen in corneal superficial and mid stroma layers, with few inflammatory cells and many proliferating stromal fibers in the lesions.The hyphae of Aspergillus presented worm-like, showing the thinner and shorter shapes in comparison with those of Candida.The hyphae of Alternaria were long,straight and thick in shape,and spherical chlamydospores were found on the hyphal tip.The hyphae, subepithelial plexus, dendritic cells, fibrosis of the cornea all showed high reflection under the laser confocal microscope, but evidently differences appeared in shape,distribution and course in corneas.Conclusions Hyphae are the main basis to diagnose fungal keratitis and differentiate fungi.As a non-invasive examination method,laser confocal microscope can provide useful information for the early diagnosis and treatment of fungal keratitis in vivo.

BACKGROUND: Apart from anticoagulation property and suppressing platelet congregation capability, tongxinluo preparation has been proved by traditional Chinese medicine to possess certain function for protecting endothelial cells.OBJECTIVE: To observe the influence of Chinese medicinal herb "tongxinluo" compound on adhesion molecule expression in brain ischemia-reperfusion (IR) animal model.DESIGN: Randomized and controlled experiment.SETTING: Department of Neurology, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA.MATERIALS: This experiment was conducted at the laboratory of the Department of Neurology, Shanghai Changzheng Hospital, between October 2002 and January 2003. Totally 25 male SD rats were randomized into sham-operation group of 5 rats, model group of 10 rats and tongxinluo group of 10 rats.METHODS: Middle cerebral artery was occluded using thread-bolt method to induce focal brain IR model in rats. In sham-operation group,nylon thread was placed around the external carotid artery approximating to the branch of internal carotid artery, and the other procedure was the same as that in model group. Rats in tongxinluo group were given tongxininfusion before IR for 1 consecutive week, which was replaced by physiological saline of the same dosage in model group and sham-operation group. Brain tissues were obtained under anesthesia condition and cut into slices; conventional HE staining, immunohistochemical and in situ hybridization staining were conducted.MAIN OUTCOME MEASURES:① The number of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)positive microvessels following IR injury.② The number of ICAM-1 and VCAM-1 mRNA positive microvessels following IR injury.RESULTS:① In sham-operation group,ICAM-1,VCAM-1 protein andICAM-1 mRNA positive microvessels could not be observed in hemispheric cortex and basal ganglion at the operative side.② In model group,the positive expression of ICAM-1, VCAM-1 protein and ICAM-1 mRNA obviously increased at the ischemic side at 6-hour reperfusion following 2-hour ischemia.③ In tongxinluo medication group,the positive protein and mRNA-expressing microvessls were found remarkably reduced in number in ischemic side hemispheric cortex and basal ganglion [(10.42 ±1.98),(12.42±2.14)/HP; (8.54±2.00), (11.12±1.56)/HP] (P ＜ 0.05), but the positive VCAM-1 protein-expressing microvessels did not change remarkably (P ＞ 0.05).CONCLUSION: Tongxinluo can suppress ICAM-1 transcription and translation following rat brain IR, thus attenuating inflammatory injury induced by brain ischemia.

Objective:To compare the difference and correlation of HPLC and enzyme-multiplied immunoassay test( EMIT) for the determination of CsA in human whole blood. Methods:A total of 119 clinical samples at different concentrations of CsA were collected and respectively determined by HPLC and EMIT. The difference and correlation of the two determination methods were investigated. Results:There was significant difference in the blood concentrations of CsA determined by HPLC and EMIT(P<0. 05). CsA concen-tration determined by EMIT was 26. 2 ng·ml-1 higher than that determined by HPLC, and 95% CI was (14. 6-37. 7) ng·ml-1 . A satisfactory correlation was achieved between the two methods(r=0. 997 4). Conclusion:There is statistically significant difference in the CsA concentration in whole blood respectively determined by EMIT and HPLC. Attention should be paid to CsA monitoring by E-MIT and HPLC, and relevant adjustment should be carried out.

OBJECTIVE:To explore the new method for clinical pharmacists training,and provide reference for improving the quality of clinical pharmacists training. METHODS:Based on the full-awareness of Definition and characteristics of stage-progres-sive learning(SPL)and problem-based learning(PBL)teaching method,SPL-PBL teaching method was used in the teaching of the-oretical and clinical practice in the process of students training in clinical pharmacist training base. The teaching course of theoreti-cal knowledge was mainly SPL in first half and PBL in another half. While in the clinical practice teaching of ward rounds,check-ing doctor's advice,participation in the development of treatment programs and case discussion,PBL was mainly used interspersed by SPL;SPL was mainly in inquiry,pharmaceutical care and medication education interspersed by PBL. RESULTS:SPL-PBL teaching method had not only effectively aroused the enthusiasm of the students'learning,enhanced the sense of responsibility and improved their clinical professional knowledge and practice ability,but also strengthened the cultivation of students communication ability,document retrieval ability,writing communication ability and self-learning ability(four abilities) to make students more quickly into the role and improve their subjective initiative. CONCLUSIONS:Practice has proved that the SPL-PBL teaching meth-od not only gives consideratin to the inndividual differences among studengts,but also mobilizes the enthusiam,and not only gives consideration to the teaching about basic theoretical knowledge,but also strengthens the training for clinical thingkig andfour abili-ties,wich can be used for the clinical pharmacists training. Meanwhile,SPL has expanded the aplication surface of PBL beacuse that SPL has reduced the requirements of PBL for overall qulity. However,it needs to be improved because of the short time appli-cation.

Objective: Epi-LASIK appeared to be effective and safe in the treatment of high myopia,but some patients complain about visual symptoms postoperation.The purpose of this study was to evaluate the high order aberrations(HOAs) of the vision-decreased eyes treated by Epi-LASIK,and to analyze the causes of postoperative glare,scieropia and monocular diplopia.Methods: We evaluated 76 eyes of 49 patients treated by Epi-LASIK with a questionnaire three months after surgery,and from them selected 34 eyes of 27 patients who scored less than 80 points and complained of postoperative visual symptoms,including glare(25 eyes in 20 patients),scieropia(7 eyes in 5 patients)and monocular diplopia(2 eyes in 2 patients).Another 42 symptom-free eyes of 22 patients treated by Epi-LASIK were included in the control group.The root mean square(RMS) of total HOAs,coma and SA were determined with the iTrace Visual Function Analyzer from the central 6.0 mm zone,and the modulation transfer function(MTF) was simulated with the iTrace 3.1 software.Results: Significant differences were found in the RMS of total HOAs,coma and SA between the eyes with visual symptoms and those without,and the values of ablation zone decentration were significantly higher in the former than in the latter(P

Objective To study optimal compatibility scheme of vidarabine monophosphate for injection combined with aciclovir injection. Methods L18(35) of orthogonal design was used with five factors: temperature, illumination,storage time,solvent and solvent dosage;the insoluble particles were observed by GWJ-4 type particle analyzer.The content of vidarabine monophosphate and aciclovir was detected by HPLC.Optimization of the best scheme of vidarabine monophosphate for Injection combined with aciclovir injection was studied.Results The regression equation of vidarabine monophosphate and aciclovir were A=3.78 ×104C+2.32, r=0.9997(n=5)and A=7.11 ×105C-4.65, r=0.9995(n=5),The results showed that the relationship between the range of 200-900μg/mL(vidarabine monophosphate) and the range of 1000-4500μg/mL(aciclovir) was good.The optimal compatibility conditions are the follows:temperature of 25,as far as possible away from light;Vidarabine monophosphate for injection 1 (0.1 g/branch) and 1 acyclovir injection (10 mL:0.5 g) mixed with 100 mL 0.9% sodium chloride injection,and dropping out within 4 h after compatibility. Conclusion The optimal compatibility scheme has good repeatability,injection solution stability is good.It prouides scientific reference for the safty of clinical rational drug use.

Objective To investigate the role of the p38 MAPK pathway in the formation of cytoplasmic vacuoles .Methods Af-ter treated with Anisomycin ,SB203580 or SP600125 ,images of HepG2 ,LM3 ,QBC939 ,Hela and A549 cells were recorded by light microscopy and taken at a magnification of 400 × .The effects of anisomycin ,SB203580 and SP600125 on the activity of p38 and JNK were measured by Western blot .LM3 and A549 cells were stained with the ER-tracker red and the lyso-tracker red and subjec-ted to confocal microscopy analysis .Results (1)Anisomycin could abolish cytoplasmic vacuolization of HepG2 cells .(2)p38 MAPK activation was responsible for anisomycin-induced cytoplasmic vacuolization abolishment .(3)p38 MAPK blocking initiated cytoplas-mic vacuoles formation in various cancer cell lines .(4)p38 MAPK blocking-induced cytoplasmic vacuoles disrupted the integrity of endoplasmic reticulum .(5)p38 MAPK blocking reversibly induced cytoplasmic vacuoles formation .Conclusion These observations provide direct evidence for a role of p38 MAPK signaling in regulating the formation of cytoplasmic vacuoles .