Objective To determine the median effective target effect-site concentration (EC50) of sufentanil when intraoperative wake-up test was successful in patients undergoing scoliosis surgery.Methods Ninety ASA Ⅰ or Ⅱ patients,aged 18-64 yr,with body mass index ＜ 30 kg/m2,scheduled for scoliosis surgery under sevoflurane and sufentanil anesthesia,were randomly divided into Ⅰ-Ⅵ groups (n =15 each).Anesthesia was induced with sufentanil,etomidate and cisatracurium,and maintained with sevoflurane,sufentanil and cisatracurium.The patients were tracheal intubated and mechanically ventilated.Before the wake-up test,infusion of cisatracurium was stopped and the end-tidal concentration of sevoflurane was adjusted to 0.The EC50 was determined by the K(a)rber method.The target effect-site concentration of sufentanil was set at 0.19 ng/ml in group Ⅰ,0.18 ng/ml in group Ⅱ and gradually decreased in decrements of 0.01 ng/ml.The wake-up test was performed 5 min later.The EC50 and 95 ％ confidence interval of sufentanil were calculated by the K(a)rber method.Results EC50 of sufentanil obtained was 0.164 ng/ml and 95％ confidence interval of sufentanil obtained was 0.157-0.172 ng/ml when the wake-up test was successful.Conclusion The EC50 of sufentanil is 0.164 ng/ml when the intraoperative wake-up test is successful in the patients undergoing scoliosis surgery.

Objective To observe the effect of treadmill training on metabotropic glutamate receptor of a middle cerebral artery occlusion model in rat and its underlying mechanisms. Methods Sprague-Dawley male rats of 2 or 3 months old were randomly divided into 3 groups: a sham operation group, an iscbemia-reperfnsion group and a treadmill training group (subject to 2 weeks of training after the ischemia-reperfusion). All the animals were sacri-ficed after 2 weeks of training and their brains were sampled for measurement of the expression level of the striatum mGluR Ⅰ-mRNA, using RT-PCR technique. Results The striatum mRNA of mGluR1 and mGluR5 was signifi-cantly elevated in the ischemia-reperfusion group(P<0.01), but treadmill training significantly suppressed the ele-vation of the expression of mRNA of mGluR1 and mGluR5 (P<0.01). Conclusions Treadmill training can signif-icantly downregulate mGluR Ⅰ-mRNA expression. This might be one of the important mechanisms for inhibition of the excitatory glutamate production.

As the actual clinical reflecting of transform Chinese medicine special curative effect, Chinese medicine preparation not only satisfies the need of hospital clinic, scientific research and teaching, but also plays an important role in deepening medical and health system reform, improving people's health level and contributing to the economic growth. However, some problems about administration and approval (tending to western medicine), contraction of the scale, lack of synchronization for clinic and scientific research, and the imbalance of regional development make Chinese medicine preparation move forwards slowly in contradiction. It has not only reduced the effectiveness of the Chinese medicine preparation in hospital clinic, but also brought bad effect on modernized development of Chinese medicine preparation. Research shows that main influencing factors of status quo of Chinese medicine preparation in medical institution include imperfect laws and regulations, high cost than income, and shortage of talents in preparation research. The analysis indicated that the necessary measures to break the contradiction, improve clinical effect of Chinese medicine, and promote the modernization development of Chinese drugs preparation were as follows: government and related departments should strengthen the supporting force in policy by adjusting the examination and approval policy, speeding up dispensing use, reforming pricing system, including into medicare reimbursement, integrating advantage resources and so on; medical institution should actively carry out research and development of traditional Chinese Medicine through drawing the traditional and modern essence, reserving professional talents, and developing characteristic preparation; companies cooperate with hospitals for complementary advantages, which can rapidly transform Chinese medicine preparation into clinical practice.
Chemistry, Pharmaceutical ; economics ; methods ; trends ; China ; Drug Discovery ; economics ; trends ; Drugs, Chinese Herbal ; chemistry ; economics ; pharmacology ; Humans ; Medicine, Chinese Traditional ; economics ; trends

Objective To investigate the effect of position ventilation(PPV) on oxygenation,the airway sputum drainage and hemodynamic of acute respiratory distress comprehensive syndrome(ARDS).Methods From June 2015 to April 2016,13 cases with moderate or severe ARDS were researched.The changes of PaO2,PaCO2,SpO2,PaO2/FiO2 and airway sputum drainage were observed as well as HR,MAP,CVP,CO,CI,SVV,etc.Results Totally 56 PPV were taken.Compared with pre-treatment of PPV,the number of PaO2 and PaO2/FiO2 increased from (74.7±13.18) mm Hg and 168.65±22.12 to (92.13±17.82) mm Hg and 208.80±24.04(P<0.05) respectively;SpO2 and airway sputum drainage increased from (95.32±2.76)% and (7.84±1.68)mL to (97.04±1.84)% and (13.25±3.55)mL(P=0.000).However,there were no significant differences in HR,MAP,CVP,CO,CI and SVV(P>0.05).Conclusion PPV can effectively improve oxygenation in patients with ARDS and promote airway sputum drainage,and hemodynamic effects are not obvious.However,nursing intervention still should be strengthened.

Bariatric surgery is one of the most effective way to lose weight,which suppresses appetite through the central nervous system. The mechanisms of appetite change may include gut hormones, adipokines, as well as microbiota in the intestine.

Background Several cytokines,especially interleukin-1β (IL-β) involve in the breakdown of blood-retina barrier,and the signal of cytokine is transduced through protein tyrosine kinase (PTK) pathway.Objective This study was to investigate the effects of PTK inhibitor,Genistein,on IL-1β-induced blood-retinal barrier breakdown and possible mechanism.Methods The animal models of blood-retinal barrier breakdown were induced through intravitreal injection of IL-1β(10ng) in 24 clean healthy SD rats and assigned to IL-1β group and Genistein group.5μl IL-1β+1μl Genistein with 0.2,1,5μg were intravitreally injected in 12 model rats and 5μl IL-1β (2mg/L)+1μl DMSO was used at the same way in other 12 models.Evans Blue was injected in rats via jugular vein in 1 hour before sacrifice of animals and the arterial blood was collected for the detect of serum Evans Blue.The retinas of the rats were obtained in 4 and 48 hours after injection of vitreous cavity to assay the content of Evans Blue in retina.The changes of vessels and infiltration of inflammatory cells were observed with hematoxylin-eosin stain.RT-PCR was employed to determine the expression of IL-8 and MCP-1mRNA in neuroretina after intravitreal injection.Expression of MCP-1 protein was localized by immunohistochemistry.Results The ratio of retinal Evans Blue and plasma Evans Blue was significantly decreased after intravitreal injection of different doses of Genistein among Genistein groups and IL-8 group with a statistical difference (4 hours:F=7.510,P=0.010;48 hours:F=5.960,P=0.019).With the increase of time after injection of Evans Blue,the ratio of retinal Evans Blue and plasma Evans Blue was gradually reduced in comparison to IL-1β group (P＜0.05).After injection of IL-1β,the dilation of retinal vessel and adhesion of leukocyte to vessel wall were seen under the light microscope,but infiltration of less inflammatory cells was found in Genistein group.The expressions of IL-8 and MCP-1mRNA were obviously declined in retina of rats in Genistein groups compared with IL-8 group (P＜0.05).Immunochemistry indicated that the expression of MCP-1 protein in neuroretina tissue was weaker in Genistein group compared with IL-8 group.Conclusion PTK inhibitor,Genistein,can decrease IL-1β-induced permeability of vessel and maintain the integrity of blood-retinal barrier by downregulating the expression of chemokines and infiltration of leukostasis in retinal vessels.This study imply that PTK pathway plays an important role in IL-1β-induced blood-retinal barrier breakdown.

Resident training is an important part of after-graduation education for medical students,and is also an important way to cultivate qualified medical talents.With 20 years management experience of resident standardized training,Xuan-Wu Hospital has found 8 aspects,including leaders'attention and implement,process management,base construction,test assessment,24-hour system,guiding teacher system,rewards and punishment system,and scientific research were related to the quality of the resident standardized training.

Objective To investigate the expression of CD14/CD16 by monocytes and the anti-inflammatory effects of hypertonic saline plus dextran (HSD) in adult blunt trauma patients in hemonhagic shock. Method A total of 30 adult patients were eligible for inclusion in the study if they sustained blunt trauma from March to October 2007 and had at least one recorded episode of hypotension (systolic blood pressure ≤ 90 mm Hg) with clear evidence of blood loss (external or internal including the thorax, abdomen or retroperitoneum). Patients were excluded if they refused to participate, were admitted ≥ 6 hours after injury, were pregnant, or had chronic disease. The enrolled patients were randomly divided in a double-blinded manner into an HSD group which was administered 7.5% Nad plus 6% dextran - 70, and a control group which was administered 0.9% NaCl. A single 250 ml dose of either HSD or NaO was immediately administered to the patients in each of the two groups while they were in the emergency room. The primary outcomes were to measure the changes in CD4/CD16 expression by monocytes and the levels of anti-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-lra and IL-10. Patient demographics, fluid requirements, organ dysfunction, infection and death were recorded. Results A total of 28 patients were enrolled with no significant differences in their clinical measurements. Hyperosmolarity was modest and transient. HSD altered the shock-induced monocyte redistribution pattern by reducing the drop in the "classic" CD14 ++ subset and remarkably affecting the expansion of the "pro-inflammatory" CD14+CD16+ subsets. In parallel, HSD significamly reduced pro-inflammatory TNF-α production while increasing anti-inflammatory IL-lra and IL-10 production. Conclusions This human trial demonstrates that HSD has anti-inflammatory and immunologic properties for trauma patients in hemorrhagic shock. HSD exerts profound immunomodulatory effects, promoting more balanced pro-/anti-inflammatory responses and reducing post-traumatic complications. Therefore, it could be useful in attenuating post-trauma multiorgan dysfunction (MOD).

Adolescent ; Cough ; complications ; Fatal Outcome ; Female ; Fever ; complications ; Humans ; Pulmonary Fibrosis ; complications ; diagnosis