OBJECTIVE:To analyze the influential factors for blood concentration of vancomycin in neonates,and to provide reference for clinical medication. METHODS:In retrospective study,114 cases of blood concentration monitoring of vancomycin were collected from neonatal department of our hospital during Jul. 1st 2014 to Jun. 30th 2015,and general information were record-ed;the influential factors for blood concentration of vancomycin were analyzed by multiple factors linear regression analysis. RE-SULTS:The blood concentrations of vancomycin in 114 neonates were 2-39 μg/ml,and average blood concentration was(13.24± 8.66)μg/ml. The blood concentrations of 43 cases were within effective range(10-20 μg/ml),accounting for 37.72%. Premature (r=0.264) and serum creatinine level (r=0.289) of neonates were positively correlated with blood concentration (P<0.05), while birth weight(r=-0.264)and body weight on monitoring day(r=-0.236)were negatively correlated with blood concentra-tion (P<0.05). The serum creatinine level (r=0.304) of prematures was positively correlated with blood concentration (P<0.05),and gestational age(r=-0.373),correct gestational age(r=-0.431)and body weight on monitoring day(r=-0.263) were negatively correlated with blood concentration(P<0.05). CONCLUSIONS:Premature,body weight,gestational age,serum creatinine level and other factors all influence the blood concentration of vancomycin. The influential factors should be considered when using vancomycin. Treatment plan should be adjusted according to the results of blood concentration and clinical symptom.

Objective:To study the effect of priming technique combined with time limit on shortening the onset time of cisatra-curium besilate. Methods:Totally 112 adult patients undergoing selective operation with general anesthesia were randomly divided into group A, B and C. Fentanyl with the dose of 4 μg·kg-1 and propofol with the dose of 2 mg·kg-1 were used in the three groups as the inducing agents. Group A was first with intravenous injection of cisatracurium besilate 20 μg·kg-1 , and 3 minutes later, the in-ducing agents and cisatracurium besilate with the dose of 80 μg·kg-1 were respectively injected. Group B was first with intravenous injection of cisatracurium besilate with the dose of l00 μg·kg-1 , and 1. 5 minutes later, the inducing agents were injected. Group C was respectively injected with the inducing drugs and cisatracurium besilate with the dose of l00 μg·kg-1 . The T1 percentage before the induction, the time of 90% and 100% inhibition of muscle twitching, the rating of trachea cannula and adverse drug reactions in the three groups were observed and compared. Results:There was no significant difference in the excellent rate of trachea cannula a-mong the three groups (P>0. 05). Compared with group A and B, group C showed no T1 suppression before the induction, while group B with T1 of (9. 8 ± 2. 6) was higher than group A with T1 of (3. 2 ± 1. 5) (P<0. 01). The time of 90% and 100% inhibition of muscle twitching in group C was the longest (P<0. 01), and the incidence of adverse drug reactions in group C was also the highest (P<0. 05). Conclusion:The application of priming principle and time limit can effectively shorten the onset time of cisatracurium be-silate with significant effect and high safety.

Objective:To observe the influence of sevoflurane and propofol anesthesia on hemodynamics in laparoscopic cholecys-tectomy. Methods:Totally 98 patients with laparoscopic cholecystectomy were randomly divided into P group and S group. P group was with propofol for anesthesia, and S group was with sevoflurane for anesthesia. Before anesthesia, 2min after intubation, 10 min af-ter intubation, 5min and 30min after pneumoperitoneum, and after the surgery, the levels of blood glucose and cortisol, and hemody-namic changes in the two groups were observed, and the incidence of adverse reactions was also studied. Results:2 min and 10 min af-ter the anesthesia, the blood glucose levels in the two groups were significantly lower than those before the anesthesia(P<0.05 or 0. 01), while 30 min after pneumoperitoneum and after the operation, the blood glucose levels were increased(P<0. 01). The blood glucose levels in S group after the operation were much lower than those in P group (P<0. 01). 2 min after intubation, cortisol was decreased in the two groups (P<0. 05 or 0. 01). 5 min after pneumoperitoneum and after the operation, cortisol levels were higher than those before the anesthesia in P group(P<0. 01), and 5 min and 30 min after pneumoperitoneum and after the operation, cortisol levels in S group were lower than those in P group (P<0. 01). HR and SPO2 showed no significant changes in the two groups during the whole process (P>0. 05). 2 min and 10 min after intubation, SBP in the two groups was decreased (P<0. 01), and 5 min and 30 min after pneumoperitoneum, there was notable difference in SBP between the groups (P<0. 01). 2 min and 10 min after intuba-tion, DBP was decreased in the two groups (P<0. 01), and the difference was significant between the groups (P<0. 01). 5 min and 30 min after pneumoperitoneum, DBP in P group had notable difference with that in S group (P<0. 05). The incidence of adverse re-actions in the two groups showed no significant difference (P>0. 05). Conclusion: Sevoflurane anesthesia in laparoscopic cholecys-tectomy can keep stable hemodynamics in the patients, and the anesthetic effect is better than propofol.

On the basis of the similarity of 7-sensation theory and psychological stress,we have approached the dependablity of anger pathopoiesis and psychological stress from pathomechanism and animal model,displaying the communication and complementation of Chinese traditional medicine and western medicine on the domain of nerve-spirit,and providing the new idea and technique for the research of entrails,function and syndrome mechanism.

Objective To observe the clinical effect of different doses of simethicone on the colonoscopy bowel preparation.Methods One hundred and fifty outpatients who received colonoscopy were randomly divided into three groups:group A1 (PEG plus 5 ml simethicone),group A2 (PEG plus 10 ml simethicone) and group B (PEG =polyethylene glycol electrolyte).The colonic cleaness,effect of removing bubbles,total procedure time,patients' satisfaction and tolerance were observed during the examination.Results The satisfaction with bubbles removal were 98.0％ (49/50),100.0％ (50/50) and 80.0％ (40/50) with significant difference(x2 =17.855,P =0.000).However,there was no difference in cleaness (x2 =1.500,P =0.472),total procedure time (Z =-0.333,P =0.765),patients' satisfaction (x2 =6.303,P =0.178) and tolerance (x2 =8.238,P =0.083).Conclusion Simethicone is of benefit for colonoscopic bowel preparation in removing air bubbles,which can enhance visibility.Five ml dose of simethicone can meet the basic need of removing air bubbles,and 10 ml dose of simethicone can exert better effects.

Objective To study the effects of mitochondrial permeability transition (MPT) on hepatocyte apoptosis and mitochondrial damage,and investigate the effects of curcumin on MPT and the related mechanisms in septic rat.Methods Fifteen healthy male Sprague-Dawley (SD) rats were randomly divided into three groups:sham group,sepsis group and curcumin group,with 5 rats in each group.Septic rat model was reproduced by cecal ligation and puncture (CLP).The rats in sham group were flipped the cecum without perforation and ligation.The rats in the curcumin group were treated with curcumin 100 mg·kg-1·d-1 (dissolved in saline to 10 mL/kg) by oral gavage for 7 days,while the other groups were treated with normal saline.Tissue samples were harvested in each group at 12 hours after operation.Pathological changes in hepatic mitochondria were observed under electron microscopy,concentration of free calcium was examined with confocal laser scanning microscope.After Fluo-3/AM staining,protein and mRNA expression of active caspase-3,Bcl-2 and Bax were examined by Western Blot and reverse transcription-polymerase chain reaction (RT-PCR).Results Under the transmission electron microscope,intact cell membrane,adqulis cytoplasm,and normal and clear mitochondrion was found in the sham group.Mitochondria in sepsis group swelled obviously with mitochondrial cristae broken or disappearance,unclear bilateral membrane structure,while the curcumin group showed much less pathological changes,with few mitochondria swell,and smear bilateral membrane structure.The fluorescence intensity index of sham group,sepsis group and curcumin group was raised successively (417.33 ± 15.88,772.95 ± 42.37,1 560.84 ± 160.78,respectively,F=184.149,P=0.000).The protein and mRNA expression of active caspase-3 and Bax had the highest level in sepsis group,followed by the curcumin group,and that in the sham group was the lowest [active caspase-3 protein (gray scale):1.698 ± 0.061,0.694 ± 0.045,0.246 ± 0.027,F=1 289.667,P=0.000; active caspase-3 mRNA (2-Δ△Ct):1.031 ±0.135,0.578 ± 0.144,0.183 ±0.036,F=66.958,P=0.000; Bax protein (gray scale):1.826 ±0.126,1.254 ±0.140,0.623 ±0.901,F=94.536,P=0.000; Bax mRNA (2-ΔΔCt):2.774 ±0.338,1.661 ±0.226,0.656 ±0.114,F=124.710,P=0.000],all of these values had statistical significance among the three groups (all P＜0.01).While Bcl-2 protein and mRNA had the highest level in curcumin group and lowest level in the sham group [Bcl-2 protein (gray scale):0.716 ±0.091,1.328 ±0.147,1.656 ±0.104,F=84.918,P=0.000; Bcl-2 mRNA (2-△ΔCt):0.617 ±0.118,1.393 ±0.096,1.650 ±0.167,F=83.846,P=0.000].The protein and mRNA expressions of Bcl-2/Bax ratio were lowest in sepsis group,then sham group,and highest in curcumin group [Bcl-2/Bax protein (gray scale):0.726 ± 0.055,1.150 ± 0.043,1.333 ± 0.163,F=46.265,P=0.000; Bcl-2/Bax mRNA (2-Δ△Ct):0.505 ±0.041,0.944±0.097,1.006 ±0.168,F=12.211,P=0.001].Conclusions MPT can lead to mitochondrial dysfunction and further cause hepatocyte apoptosis.Mechanism of effect of curcumin on MPT may be related to reduction of intracellular calcium concentration,promotion of anti-apoptotic Bcl-2 gene expression,inhibition of caspase-3 activation and Bax gene.

Objective To introduce and translate the Coping-adaptation Processing Scale:Short Form-15 items (CAPS:SF) and evaluate the reliability and validity among people after losing the only-child. Methods CAPS:SF was translated into Chinese (CV-CAPS:SF) according to Brislin. A sample of 77 people after losing the only-child were recruited to complete the scale to evaluate the reliability and validity of scale. Results The scale-content validity index of the CV-CAPS:SF was 0.94;the Cronbachαwas 0.85 and split-half coefficient was 0.84. The score of coping was (38.60 ± 5.30) points. The take strength from spirituality or the successes of courageous people was the highest (3.44±0.50) points;the use humor in handling the situation was the lowest (2.05±0.58) points. Different age, education degree, marital status, occupation, average monthly income of latest year, the length after losing the only-child in the face of the difference was statistically significant (t/F=7.636-85.130, all P<0.05). Conclusions The CV-CAPS:SF is reliable and valid. It could be used to help the nursing staff understand coping among people after losing the only-child .

Objective To observe the effect of Ulinastatin (UTI) on intestinal barrier function of elderly patients with sepsis in order to explore an optimized program of early treatment for such patients instituting a guidelines for clinical practice.Methods All selected patients randomly (ramdom number) divided into conventional treatment group (n =34) and UTI treatment group (n =34).Peripheral venous blood samples of elderly patients with sepsis were routinely taken at days 0,2,3,7 (D0,D2,D3,D7) after admission for detecting the changes of ptasma values of Intestinal fatty acid binding protein (IFABP),Diamine oxidase (DAO),and D-lactate (D-Lac).While patients' APACHE Ⅱscores,length of ICU stay and 28 d mortality also were recorded at the same time.Results At admission,there were no significant differences in patients' APACHE Ⅱscores,plasma values of IFABP,DAO and D-Lac between two groups (P ＞ 0.05).During the course of treatment,the patients' APACHE Ⅱscores,plasma values of IFABP,DAO and D-Lac were declining in both groups,while those declinations in UTI group showed significantly more prominent.Compared with conventional therapy group,IFABP level was significandy lower in UTI group (P ＜ 0.05),and the plasma values of DAO and D-Lac were significantly lower at D2 and D3 in UTI group (P ＜ 0.05),but not at D7 (P ＞ 0.05).The plasma levels of IFABP,DAO and D-Lac were positively associated with APACHE Ⅱscores,but not with length of ICU-stay (P ＞0.05).After treatment,28d mortality did not differ significantly between the two groups (P ＞0.05).Conclusions UTI has a protective effect on intestinal barrier function in elderly patients with sepsis.UTI can improve the prognosis of elderly patients with sepsis and reduce ICU stay,while has no significant effect on reducing 28 d mortality.

Objective:To explore the prognostic value of CysC and NT‐proBNP in patients with non‐ST elevation a‐cute coronary syndrome (NSTE‐ACS) .Methods :A total of 166 NSTE‐ACS patients hospitalized in our hospital from Jan 2012 to Dec 2012 were selected .They were followed up for 12 months ,then general data ,levels of CysC , NT‐proBNP ,hsCRP and cTnI etc .and incidence rate of MACE were recorded and measured .According to MACE occurrence during follow‐up or not ,156 cases were divided into non‐MACE group (n=137) and MACE group (n=19) ,risk factors for MACE in NSTE‐ACS patients were analyzed ,receiver operator characteristic curve (ROC) was performed ,and the optimal cutoffs of related indexes predicting MACE occurrence in these patients were analyzed . Results :Compared with non‐MACE group ,there were significant rise in age [ (60.26 ± 10.45) years vs .(64.16 ± 11.21) years] ,levels of CysC [ (1.02 ± 0.11) mg/L vs .(1.15 ± 0.12) mg/L] ,NT‐proBNP [ (251.97 ± 89.65) pg/ml vs .(347.93 ± 107.29) pg/ml] ,hsCRP [ (14.69 ± 3.53) mg/L vs .(17.13 ± 3.68) mg/L] and cTnI [ (0.36 ± 0.46) ng/ml vs .(0.90 ± 0.88) ng/ml] in MACE group ,P<0.05 or <0.01. Multi‐factor regression analysis indica‐ted that CysC ,NT‐proBNP and cTnI levels were independent predictors for MACE in NSTE‐ACS patients ( P<0.05 or <0.01) .ROC curves of CysC ,NT‐proBNP ,cTnI and hsCRP judging prognosis were drawn , only AUC of CysC and NT‐proBNP curves were >0.7 [CysC:0.784 ,95% CI:0.687~0.881 ;NT‐proBNP:0.753 ,95% CI :0.639~0.867] , and it′s analysis indicated that CysC=1.07 mg/L and NT‐proBNP=279.60 pg/ml were their optimal cutoff predicting MACE .Kaplan‐Meier survival curves with above two cutoffs as risk stratification cutoff indicated that survival time of high risk group was significantly shorter than that of low risk group (P<0.05) .Conclusion:Serum CysC and NT‐proBNP levels are independent predictors assessing prognosis in NSTE‐ACS patients .