Objective:To observe the analgesia effect and of low-level combined- and single-laser irradiation on Zusanli (ST 36) in rats and the relationship between mast cell degranulation and laser acupuncture analgesia.Methods: A total of 66 Sprague Dawley (SD) rats were randomly assigned into normal control,model control,sham irradiation,10.6 μm laser (220 mW,40 Hz) 650nm laser(36mW,continuous),combined laser (10.6 μm+ 650 nm) groups.Arthritis mode 1 was established by injection of Complete Freund's Adjuvant (0.05 mL) into the left ankle joint.The paw withdrawal latency (PWL) was detected with a radiant heat algesimeter.Zusanli (ST 36) was irradiated with sham,single or combined laser for 30 min.After sacrifice under anesthesia (1% embutal),tissues of Zusanli (ST 36) area were sampled,sliced (5 μm) and stained with Toluidine Blue for skin for observing the mast cell degranulation.Results:Compared with model control and sham group,the pain threshold increased significantly in 650nm and combined laser groups (P＜0.01),while remained no significant difference in 10.6 μm group.Compared with model and sham group,the degranulation ratios of mast cells in 650nm and combined laser group were significantly higher (P＜0.001),while remained no significant difference in 10.6 μm group.The linear correlation coefficient between degranulation ratios of mast cells and PWL after laser acupuncture is 0.737 (P＜0.001).Conclusion:Both 650 nm and combined laser stimulation of Zusanli (ST 36) can effectively raise pain threshold,and enhance degranulation ratio of mast cells at the stimulated acupoint.The result also suggested a linear correlation between degranulation ratio of mast cell and analgesia effect.

The enzymatic synthesis of endomorphins were carried out by immobilized papain on sodium alginate-chitosan (IPSAC). The reaction has been carried out in two steps. First, Trp-Phe-NH2 was obtained by Boc-Trp-OH coupling with Phe-NH2 using IPSAC catalyst in microaqueous acetonitrile system with a 27.8 % yielding as determined by high performance liquid chromatography (HPLC). The catalytic properties of IPSAC were examined by studying the dependence of pH, ionic strength, solution content, reaction temperature,enzyme loading and reaction time over the yields. The results of orthogonal experiments indicated that pH was the most significant factor that influenced this synthesis. Second, Boc-Tyr-Pro-OMe and Trp-Phe-NH2 were suspended into the microaqueous acetonitrile to produce Tyr-Pro-Trp-Phe-NH2 (endomorphin-1) with a 35.2% yield.

In order to separate chiral D-phenylalanine from L-phenylalanine,the enzyme catalytic method by papain and immobilized papain were used in this investigation.It indicated that the yield rate of N-acetyl-DL-phenylalanine synthesized from DL-phenylalanine was 88.7%.The ionic strength was the strongest influencing factor in the synthesis of N-acetyl-L-phenylalanylaniline by both papain and immobilized papain on sodium alginate-ehitosan(IPSAC).But the reaction temperature was the strongest influencing factor in the synthesis by immobilized papain on nylon cloth(IPN).The ionic strength and the pH were the important influencing factors in the synthesis.The yield rates of the best synthesis system of N-acetyl-L-phenylalanylaniline by papain,IPSAC,IPN were 61.2%,54.7%,36.3%,respectively.The yield rate of L-phenylalanine from N-acetyl-L-phenylalanylaniline hydrolyzation was 59.2%.The optical purity of the product was 96.6%.The vield rate of D-phenylalanine from N-acetyl-D-phenylalanine hydrolyzation was 61.7%.The optical purity was 95.7%.

Objective: To evaluate the effects of 650 nm-10.6 μm combined laser in patients with knee Osteoarthritis (OA) and to determine whether the combined laser provides greater pain relief and improved function compared with red light. Methods: Forty-eight patients with knee OA were randomly allocated to two groups (24 per group), receiving 20 rain irradiation with 650 nm -10.6 μm combined laser or red light emitting diode respectively on point Dubi (ST 35) 3 times a week for the first course (2 weeks) and twice a week for the second one (4 weeks). The main outcome measures were WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores. In addition, patients' global assessment, adverse effects and validation of patient blinding were analyzed. Results: All the patients completed the first course, but 12 were lost during the second one. Due to the high dropout rate by the second course, only the data acquired from the first course could be analyzed. No differences of general data of patients and WOMAC scores were found in between-group comparison before treatment (P>0.05). The WOMAC scores of patients in both combined laser group and red light group reduced significantly compared to baseline by the end of the first course (P<0.01). There were no significant differences on the reduction rate of WOMAC scores between two groups (P>0.05). Neither the patients' global assessment nor the dropout rate showed statistical differences between two groups (P>0.05). There was no difference between two groups in patients correctly guessing the treatment assignment (P>0.05). There was no significant difference in the reduction rate of WOMAC scores and the patients' global assessment between patients who guessed their assignment (P>0.05). Conclusion: Both combined laser and red light irradiation are beneficial to patients with knee OA. But as the statistical indifferences between two groups, the authors can't conclude from this study whether the combined laser is more effective.

Objective To explore the clinical effect of precise radiotherapy in the treatment of cancer in elderly patients. Methods We selected 88 elderly patients with advanced cancer at our hospital from January 2012 to December 2015.The patients were assigned into a control group(n＝44) treated with conventional radiation therapy and an intervention group (n＝44)receiving precise radiation therapy.Clinical effects and treatment reactions and adverse events were compared between the two groups. Results The total effective rate was higher in the intervention group than in the control group ,but the difference was not significant [40.9%(18/44)vs 56.8%(25/44) ,χ2＝ 2.228 ,P ＝0.135] .The control rate of clinical diseases was higher in the intervention group [77.3%(34/44)]than in control group[56.8%(25/44)](χ2＝ 4.166 ,P＝ 0.041).The incidence of adverse reactions was significantly lower in the intervention group [43.2%(19/44 )] than in the control group [68.2%(30/44)] ,(χ2＝ 5.572 ,P ＝ 0.018 ). Conclusions Precise radiotherapy has a precisely clinical efficacy and a lower incidence of adverse events. It is worth recommending and generalizing.

Objective To investigate the effects of problem-based learning (PBL),case-based learning (CBL) and team-based learning (TBL) teaching method in the training of ophthalmic nurses.Methods Totally 14 nurses in a hospital were selected and randomly divided into two groups:six in the control group and eight in the intervention group.During the three months of training,nurses in the control group received LBL teaching method,while nurses in the intervention group were trained with the combination of PBL,CBL and TBL teaching method.Theoretical and skills results were recorded and compared between two groups,and the teaching efficiency was investigated.Results After training,theoretical and skills results in the intervention group were all higher than that in the control group (P＜0.05);through the questionnaire survey," appropriate evaluation" dimension has no statistically significant difference (P＞0.05);"Suitable study burden" dimension in the control group got higher score (P＜0.05);the rest of indicators in the intervention group were all higher than that in the control group (P＜0.05).Conclusions The application of the combination of TBL,PBL and CBL teaching method can stimulate nurses' study interest and enthusiasm as well as communication and clinical practice skills.

Objective? To construct new nurses＇ humanistic care training modules based on the concept of "craftsman spirits", so as to provide the basis of training for nursing managers to improve nurses＇ humanistic care behavior. Methods Underpinned by the "craftsman need-to-know 30 items" in "craftsman spirits", we reviewed the literature about nurses＇ humanistic care training status and patients＇ humanistic needs, and selected 20 typical clinical nursing managers and educators from 3 cities in Jiangsu Province and conducted 2 rounds of consultation by Delphi expert consultation method; we used analytic hierarchy process (AHP) for indicators at various levels to determine the contents and weights of humanistic care training modules for new nurses. Results? After two rounds of consultation, the recovery rate was 100%, the expert authority coefficient (Cr) was 0.92 and 0.87 respectively, and the coordination coefficient(W) was 0.32 and 0.23. The training module of humanistic care for new nurses was finally formulated, including 6 primary indicators, 15 secondary indicators and 30 tertiary indicators. Conclusions The construction method of the new humanistic care nurse training module based on the concept of "craftsman spirits" is scientific and vigorous, the contents are specified and easy to apply, with an emphasis on nurses＇ internal literacy and understanding of the development of the discipline.

OBJECTIVE:To investigate the omeprazole off-label use and provide reference for rational drug use in clinic. METHODS:In retrospective survey,1838 omeprazole prescriptions were selected from outpatient department during Jun. 2014 to May 2017 by random number table. According to the latest drug instruction,whether the off-label use or not was determined. Off-label use was determined by reviewing domestic and foreign guidelines,literatures and Micromedex database. RESULTS:Among 1838 pre-scriptions,there were 1750 prescriptions of off-label drug use (95.21％),involving 13 items and 3 types of off-label drug use. Main type of off-label drug use was over-indication medication,involving 1747 prescriptions (96.47％). There was no statistical significance in the incidence of off-label drug use between digestive department and non-digestive department or among physicians at different levels(P>0.05). Among 13 items of off-label drug use,7 items were supported by evidence-based medicine evidence of domestic and foreign guideline,expert consensus/suggestion or literature reports,etc.;among which 1 item of off-label drug use were included in Micromedex grading system and other 6 items had no evidence-based medicine evidence. CONCLUSIONS:The phenomenon of omeprazole off-label use is widespread in outpatient department of the hospital,and some off-label drug use are sup-ported by evidences. There are differences in the quality of those evidences. It is suggested to standardize the off-label drug use to avoid legal risks and guarantee the safety of drug use for patients.

Objective:To construct a prediction model for difficult tracheal intubation in the patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods:A total of 324 patients with OSAHS undergoing surgery with general anesthesia, admitted to our hospital from June 2019 to June 2021, were included in model group, and 175 patients with OSAHS undergoing surgery with general anesthesia, admitted from July 2021 to July 2022, were selected and served as validation group. The patients in model group were divided into occurrence group and non-occurrence group according to whether difficult tracheal intubation occurred. Logistic regression was used to construct the prediction model, and R4.2.1 software was used to draw the risk nomogram and calibration curve. The predictive accuracy of the model was evaluated by the area under the receiver operating characteristic curve.Results:Body mass index (BMI), sagittal minimum cross-sectional area, horizontal minimum cross-sectional area and mandibular distance were risk factors for difficult tracheal intubation in OSAHS patients ( P<0.05). A prediction model was developed using the above factors: Logit P=33.726+ 1.411×BMI score-0.014×sagittal airway minimum cross-sectional area-0.013×airway horizontal minimum cross-sectional area-0.312× mandibular distance. The area under the receiver operating characteristic curve was 0.846, Youden index 0.585, sensitivity 0.831, specificity 0.755, and the accuracy 0.889 (Hosmer-Lemeshow test χ2=9.24, P=0.322) in model group. The area under the external validation curve was 0.802, Youden index 0.545, sensitivity 0.636, specificity 0.908, and the accuracy 0.893 (Hosmer-Lemeshow test χ2=10.24, P=0.287) in validation group. Conclusions:The prediction model based on BMI, sagittal minimum cross-sectional area of airway, horizontal minimum cross-sectional area of airway and mandibular distance has a high value in predicting the risk of difficult tracheal intubation in patients with OSAHS.