Objective To examine the difference in the onset of and recovery from the neuro-muscular (N-M) blockade induced by rocuronium measured by acceleromyography of corrugator supercilli (CS) muscle and adductor pollicis (AP) muscle and the implication for clinical N-M monitoring. Methods Forty ASA Ⅰ - Ⅲ patients aged 32-65yr undergoing elective cholecystectomy or gastrectomy under combined general-epidural anesthesia (CGEA) were randomized to receive rocuronium 0.6 mg?kg-1 (group A, n = 20) or 0.9 mg?kg-1 (group B, n = 20) to facilitate tracheal intubation. Patients with N-M transmission disease, serious heart and lung disease or hepato-renal dysfunction were excluded. Epidural was performed at T8-9 or T9-10 . The level of epidural block was below T4. N-M blockade was measured by acceleromyography (TOF-WATCH SX Organon Teknika) of AP muscle at the thumb and CS muscle at the superciliary arch simultaneously. General anesthesia was induced with midazolam 0.05 mg ? kg-1 , propofol 2 mg ? kg-1 , fentanyl 3 ?g ? kg-1 and rocuronium 0.6 or 0.9 mg ? kg-1 . Tracheal intubation was performed at 80 % depression of T1 . The intubation condition (rated as excellent, good, medium, poor). The onset time (time from injection of rocuronium to maximal depression of T1) and the time of return to 25% and 75% of the control height of T1 were recorded and recovery index (RI) was calculated. Results The onset time of N-M block of CS muscle was (111?36)s at 0.6 mg?kg-1 and (74 ? 26)s at 0.9 mg?kg-1 and that of AP muscle was (106 ? 34) s (0.6 mg?kg-1 ) and (84?28) s (0.9 mg?kg-1 ) . The onset time produced by 0.9 mg?kg-1 was significantly shorter than that produced by 0.6 mg?kg-1 . At 0.6 mg?kg-1 80% depression of T1 of AP muscle was equal to 66% (52%-81 % ) depression of T1 of CS muscle and only 2 out of 10 patients showed good intubation condition. At 0.9 mg?kg-1 80% depression of T1 of AP muscle was epual to 89% (76%-93%) depression of T1 of CS muscle and all patients showed good intubation condition. The recovery of CS muscle from relaxation was faster than that of AP muscle. Conclusion There are differences in the onset of and recovery from the N-M blockade induced by rocuronium between CS and AP muscle. Monitoring N-M blockade of CS muscle is better for intubation.

Objective:To discuss the therapeutic effect of pharmaceutical care for old patients with chronic obstructive pulmonary disease ( COPD) . Methods:Totally 192 patients diagnosed as COPD were randomly divided into 2 groups according to a random num-ber table, 100 cases in the experimental group and 92 cases in the control group. The control group was treated with the conditional therapy, and the experimental group was treated with pharmaceutical care additionally. The studieds on COPD assessment test ( CAT) , modified British medical research council ( mMRC) and the value of pulmonary function index ( FEV1% index) were carried out and compared between the two groups. Results:There was no statistically significant difference in the CAT score, mMRC classification and FEV1% index between the two groups on admission (P>0. 05), however, after the treatment, the CAT score and mMRC classifica-tion were decreased and FEV1% index was increased in the two groups, and there was statistical significance between them ( P <0. 05). The CAT score and mMRC classification in the experimental group were lower and FEV1% index was higher than that in the control group(P<0.05). Compared with the medication errors(n=13, 14.13%) and incidence of adverse drug reactions(n=5, 5. 43%) in the control group, the medication errors(n=2, 2. 0%) and incidence of adverse drug reactions (0%) in the experimental group were significantly decreased. Conclusion:Clinical pharmacists provide effectively pharmaceutical care, which can significantly improve the clinical therapeutic efficacy in old patients with COPD.

Objective To compare the therapeutic effects of transcervical resection(TCRC) and loop electrical excision procedure(LEEP) for the treatment of moderate-to-severe chronic cervicitis.MethodsFrom January 2003 to July 2006,totally 520 patients with moderate-to-severe chronic cervicitis were randomly divided into two groups to receive TCRC or LEEP.ResultsThe intraoperative blood loss in the TCRC group was significantly less than that in the LEEP group [(4.2?1.3) ml vs(10.1?4.5) ml,t=-20.310,P=0.000].Whereas,no significantly differences were found in the drainage and bleeding time and cure rates between the two groups [(15.9? 3.7) d vs(16.2? 3.3) d,t=-0.976,P=0.330;and 95.2%(236/248) vs 93.2%(235/252),?2=0.832,P=0.362].ConclusionsBoth TCRC and LEEP are effective for chronic cervicitis.TCRC is superior to LEEP in the surgical outcomes;however the latter is easier to perform than TCRC.

Objective To investigate the influence of Trisialoganglioside-GTlb combined with Edaravone Injection on clinical effect and serum related indicators in patients with acute cerebral infarction.Methods A total of 126 cases of patients with acute cerebral infarction in our hospital from October 2010 to May 2016 were selected and divided into observation group and control group,63 cases in each group.Patients in the control group were treated with regular treatment and Edaravone Injection,and patients in the observation group were treated with regular treatment,Edaravone Injection and Trisialoganglioside-GTlb.The clinical effect,NIHSS scores,Barthel index scores,serum level of neuron specific enolase (NSE),S100β protein,superoxyde dismutase (SOD),advanced oxidation protein products (AOPP) and malondiadehyde (MDA) were compared.Results The total effective rate of the observation group (90.48％) was significantly higher than that of the control group (76.19％),the difference between the two groups was statistically significant (P ＜ 0.05).After two weeks of treatment,two groups of NIHSS and Barthel index scores were significantly lower than before treatment,the difference was statistically significant (P ＜ 0.05);and the NIHSS and Barthel index scores of observation group were significantly lower than that of control group,the difference was statistically significant (P ＜ 0.05).NIHSS scores,Barthel index scores of the observation group were significantly better than that of the control group (P ＜ 0.05);The serum level of NSE,S100,AOPP,MDA of two groups after treatment were significantly lower than that before treatment,the difference was statistically significant (P ＜ 0.05);and the above indexes of the observation group was significantly lower than the control group,the difference was statistically significant (P ＜ 0.05);SOD levels of two groups were significantly increased than before treatment,the difference was statistically significant (P ＜ 0.05);and the SOD levels of observation group was significantly higher than that of control group,the difference was statistically significant (P ＜ 0.05).Conclusion Trisialoganglioside-GT1b can synergy improve the clinical effect of Edaravone Injection in patients with acute cerebral infarction,and be good to recovery the neurologic function and ability of daily living,and these may be related to the change of the serum level of NSE,S100β protein,SOD,AOPP and MDA.

For the past few years,with the extensive application of nanoparticle technology in photodynamic therapy (PDT) of cancers,there have been some improvements of the stability of photosensitizers,the tumor targeting,the working depth and the yield of singlet oxygen by a variety of ways.Furthermore,with nanoparticle,PDT also can be combined with some other treatments together.Finally,the use of nanoparticle vectors for PDT is a novel and promising approach which might improve the efficiency of photodynamic therapy for tumors,overcome many adverse effects and increase the indications of PDT.

Objective:To analyze the 3D changes of pharyngeal airway in patients with skeletal Class Ⅲ malocclusion after rapid maxillary expansion(RME)and maxillary protraction.Methods:53 patients underwent orthodontic treatment with Hyrax palatal ex-panders and maxillary protraction.Cone-Beam computed tomography(CBCT)scan was taken before treatment(T0),after 1 6 d RME (T1 )and after about 5 month maxillary protraction(T2).Data were reconstructed into 3D model,sagittal and transversal measure-ments,cross sectional areas,volumes of the pharyngeal airway were computed.Results:After RME,the transversal measurements, cross sectional areas,volumes of nasal passage were increased(P <0.05).After maxillary protraction,the 4 nasopharyngeal measure-ments were increased(P <0.05).Conclusion:RME and maxillary protraction may increase pharyngonasal airway.

Objective To evaluate the accuracy of systolic pressure variation (SPV) in monitoring blood volume in patients.Methods Twenty-two ASA Ⅱ or Ⅲ patients (17 male,5 female),aged 49-79 yr,with body height 153-173 cm,weighing 55-89 kg,scheduled for elective coronary artery bypass grafting under cardiopulmonary bypass,were studied.Stroke volume variation (SVV) was monitored based on the arterial pressure wave and SPV measured based on the invasive arterial pressure wave after changing the title.After the chest was closed,the volume load test was immediately carried out.6％ hydroxyethyl starch 130/0.4 50-80 ml/min was infused via the jugular vein until cardiac index (CI) increased by 10％.HR,mean arterial pressure (MAP),SPV,CI,SVV,stroke volume index (SVI),systemic vascular resistance index (SVRI),central venous pressure (CVP),and pulmonary capillary wedge pressure (PCWP) were recorded in supine position (T1),at 30° head-down tilt before skin incision (T1'),before (T2) and after opening the chest in supine position (T2'),before (T3) and after the volume load test in supine position after closing the chest (T3'),in supine position after skin closure (T4),and at 30° head-down tilt after skin closure (T4').The difference in SPV and SVV (△SPV and △SVV) was calculated.The receiver operator characteristic curve for △SVV and △ SPV in determining blood volume changes was plotted.Results MAP,CVP,PCWP,CI,and SVRI were significantly increased,while SVV and SPV were decreased at T1' compared with those at T1 (P ＜ 0.05).HR was significantly increased,while CVP was decreased at T2' compared with those at T2 (P ＜ 0.05).MAP,CVP,PCWP,and CI were significantly increased,while SVV and SPV were decreased at T3' compared with those at T3 (P ＜ 0.05).MAP,CVP,and PCWP were significantly increased,while SVV and SPV were decreased at T4' compared with those at T4 (P ＜ 0.05).The area under receive operator characteristic curve for △SVV and △SPV in determining blood volume changes was 0.603 and 0.616 respectively,and there was no significant difference (P ＞ 0.05).Conclusion SPV can accurately monitor the blood volume in patients.

Objective To observe the efficacy of transjugular interventional therapy for patients with hepatic myelopathy after transjugular intrahepatic portosystemic shunt (TIPS).Methods Sixteen patients with hepatic myelopathy afte TIPS were treated with interventional therapy again.Four patients who were treated with drugs through shunt previously had poor prognosis,then the remaining 12 patients treated with current limited shunt had better prognosis,which were analyzed in this study.Activities of daily living were assessed by Barthel index,limb muscle strength scores were assessed by Lovette scoring system.The changes of liver function and portal vein pressure were analyzed by paired t-test,while other data such as serum ammonia level,Barthel index,Lovette scores before and after transjugular interventional therapy were compared by analysis of variance with repeated measurements.Results All the patients had no complication after operations.The liver function and portal vein pressure of 12 patients had no significan change before and after operation.Blood ammonia value were (77.9 ± 17.9) mmol/L after TIPS,(77.9 ± 14.8),(73.4 ± 21.5),(59.5 ± 14.5),(52.0 ± 16.5) mmol/L 1,3,6,12 months after current limited shunt.Compared with that of preoperation(F =6.45,P ＜0.05),it decreased significantly at the 6th and 12th month.Limb muscle strength scores were 2.1 ± 0.7 before current limited shunt,2.3 ± 0.8,3.1 ± 1.0,3.2 ± 1.1,2.8 ± 0.9 1,3,6,12 months after the operation.Compared with preoperation (F =4.97,P ＜ 0.05),muscle strength grading improved significantly at the 3rd,6th and 12th month.Activities of daily living Barthel index were 42.1 ± 10.5 before current limited shunt,47.1 ± 11.0,45.0 ± 8.8 3,6 months after the operation.Compared with preoperation (F =5.05,P ＜ 0.05),activities of daily living had improvement.There were 3,6,2,1 cases of hepatic encephalopathy of Ⅰ,Ⅱ,Ⅲ,Ⅳ stage after TIPS.Three months after current limited shunt there were 7,3,1,0 cases,while there were 8,1,1,0 cases 6 months after the operation.In other 4 patients treated with drugs,2 patients died of liver failure,one was lost to follow.Conclusions Interventional therapy can relieve symptoms of hepatic myelopathy.The operation is safe,effective,and helpful after TIPS treatment.

Objective To detect the best phase and best tube voltage for the diagnosis of small (diameter ≤ 3 cm) clear cell renal cell carcinoma with dual-energy dual-phase CT.Methods Image manifestations of 27 patients with small (diameter ≤ 3 cm) ccRCCs confirmed by pathology were retrospectively analyzed.All subjects underwent dual-energy biphase (early corticomedullary and delayed phase) scan preoperatively.Two senior radiologists analyzed the images in consensus.The definition of images in different phases and with different tube voltage was classified into 4 levels and was compared by Wilcoxon and Friedman test.The attenuation of the lesions and the adjacent renal parenchyma,the SD value of the anterior abdomen fat were measured.The contrast noise ratio (CNR),lesion kidney ratio (LKR) and the early corticomedullary phase and delayed phase value were calculated.They were all compared with oneway ANOVA.Results The score of definition of lesions in early corticomedullary phase at 80 kV,140 kV and average-weighted 120 kV were 3.30 ± 0.87,2.81 ± 0.92 and 3.11 ± 0.85,respectively,which in delayed phase were 3.70 ±0.54,3.30 ±0.82 and 3.52 ±0.64,respectively.Definition of lesions was better in delayed phase than that in early corticomedullary phase (Z =-2.296,-2.446 and-2.392,respectively; P ＜ 0.05).Either in early corticomedullary phase or in delayed phase,CT value,noise value and CNR were the highest on 80 kV images,which were(302 ± 80)HU,(16.2 ± 2.2) and (4.1 ± 3.4) in corticomedullary phase and (152 ± 31) HU,(16.4 ± 2.7) HU,and (4.7 ± 1.7) in delayed phase.The change of lesion attenuation between early corticomedullary phase and delayed phase on 80 kV,140 kV and averageweighted 120 kV images were (150 ± 76),(72 ± 33) and (96 ± 46) HU,respectively.There was significant difference among the three groups (F =4.541,P ＜ 0.01).Conclusions Delayed phase scan is in favor of small clear cell renal cell carcinoma display.80 kV images are the best for detecting and qualitation of small clear cell renal cell carcinoma when compared with 140 kV and the average-weighted 120 kV images.

In vitro or in vivo results of investigations into the development of photosensitizer drug delivery systems have demonstrated that the use of vehicles not only enhance the stability of photosensitizer,but also promote the accumulation of photosensitizer in tumor tissue,enhance the targetability of photodynamic therapy,the working depth,the yield of singlet oxygen and overcome many untoward effects.So the research of new photosensitizer drug delivery system has important application value in photodynamic therapy of tumor.