To assess the concentration-responses relationships of propofol, 16 adult patient,ASA grade Ⅰ-Ⅱ,scheduled for upper abdominal operation, were randomly allocated to undergoing epidural block (group Ⅰ, n = 8)or combined anesthesia (group Ⅱ, n = 8) respectively. After a bolus injection of propofol 2.5mg ?kg, blood pressure (BP), heart rate (HR) and tidal volume (TV) were recorded, and drowsiness,amnesia,cooperation and orientation were evaluated by scorring scales in both groups. The venous samples were taken before and after the administration to measure the propofol plasma concentration by spectrofluorophotometric detector. The results revealed that there were no significant differences in pharmacokinetic parameters between two groups;the plasma concentration of propofol at 2. 5rag. L~(-1) was required for adequate anesthesia,and 1.5 to 1.9rag. L~(-1) for hypnosis,the patients were fully awake at 0.94?0.3mg. L~(-1); BP,HR and TV were significantly depressed at more than 2.0rag. L~(-1), and recovered to baseline at less than 1.5mg. L~(-1). It is suggested that there are good relationships between propofol plasma concentrations and its pharmacodynamic responses.

Objective To examine mycological profile of eryptococcal meningitis in patients with non-acquired immune deficiency syndrome (AIDS) during treatment and follow-up so that to support clinical therapy. Methods Data of 28 cuhure-confirmed cryptoeoccal meningitis patients with non-AIDS were retrospectively analyzed. Fungat smear, count, culture and latex agglutination test of cerebrospinal fluid (CSF) were done during treatment and follow-up. Initial treatment included intravenous amphotericin B plus oral flucytosine or f;uconazole for at least 6 weeks, and consolidation treatment included oral fluconazole and (or) itraeonazole for at least 2 months. All 28 patients were cured. The data were analyzed by rank-sum test. Results The positive rate of CSF fungal smear was 92.9% before treatment and gradually decreased, and the fungal count was significantly reduced over time after treatment. While fungal smears of some patients were still positive after initial treatment. Fungal growth time in culture was gradually extended, and fungal culture turned to be negative in all patients after 2 weeks of treatment. The positive rate of latex agglutination test of CSF was 100%. Cryptococcal antigen titer decreased steadily after treatment, which was not correlated with the decrease of fungal count. Conclusion Mycological tests of patients with eryptococcal meningitis should be interpreted comprehensively during treatment, and result of each test should be specifically analyzed.

Objective To explore the application of the evidence-based case report method in the standardization training of resident physicians in the department of endocrinology. Methods Fifty-one resi-dents recruited from the endocrinology department were randomly divided into the experiment group (26 cases) and control group (25 cases). The evidence-based case report method was conducted in the ex-peri-mental group, while the traditional clinical teaching mode was applied in the control group. The re-sults of the examination of two groups including the theoretical test and skill test were compared and the question-naire survey was conducted to find out the differences of students' interest in learning, clinical skills and satisfaction. All data were compared using t test. Results There was no significant difference in theoretical test between the two groups (P>0.05). The total score of the skill test in the experimental group was (85.13 ±4.63) and the control group was (76.79 ±3.11) (P=0.000). The students in the experimental group showed that the teaching method had more significant effects on improving their learning interest and initiative, clinical thinking ability, clinical work ability, literature review ability and medical article writing ability. Scores of satisfaction with teaching methods (total score was 10) for experimental group were (9.69 ±0.34), which was also significantly higher than those in the control group (8.01 ±0.39) (P=0.000). Conclusion The application of evidence-based case report teaching method in the standardized training of resident physicians in department of endocrinology is worthy of being perfected and further popularized in clinical teaching work.

Objective To evaluate the influence of tissue factor pathway inhibitor 2(TFPI-2)gene on the proliferation and invasion of K562.Methods The expression vector pcDNA3.0/TFPI-2 was transfected into human leukemia line K562 cells(K562-T)by using liposome,then the mRNA and protein TFPI-2 were detected by real-time RT-PCR and western blot separately.The growth curve and the colony-forming unit assay were used to measure the ability of cells growth and transwell chamber model was employed to test the ability of cell invasion in vitro.Results Expression of mRNA and protein of TFPI-2 was detected in transfected cells.The growth rate and self-replication ability of K562-T cells were lower than those of the two control groups obviously.The number of K562-T cells to traverse a Matrigel-coated membrane was dramatically decreased compared with that of non-expressing cells.Conclusion The gene of TFPI-2 can inhibit the growth,proliferation and invasion of the K562 cells.

Under the guidance of strengthening medical undergraduates' practical ability and their competence in future jobs, Dalian Medical University has established a clinical medical talents practical ability training mode. This model has implementedThree Turnsclinical skills training pattern to strengthen the three stage (before, during and after practice) clinical skills training and concentrated on humanistic quality education through overall evaluations and set up clinical skill examination system to evaluate teach-ing effectiveness comprehensively and truly , which has effectively improved the quality of education by perfecting safeguard mechanisms and guaranteeing teaching quality.

Objective To explore the application value of low-flow rate and-contrast injection scheme for pulmonary artery computed tomography angiography(CTA)in the elderly patients.Methods Sixty elderly patients undergoing pulmonary artery CTA in some hospital from April 2020 to January 2023 were selected and divided into a control group(30 cases)and an experimental group(30 cases)according to the contrast agent injection schemes.A conventional contrast injection scheme was used for the control group,and an optimized contrast injection scheme with low flow rate and low contrast dose was designed for the experimental group.The two gorups were observed and subjectively scored in terms of the degree of pulmonary artery enhancement,the display of pulmonary artery trunks and branches and the sharpness of image vessel edges,and objectively evaluated for the degree of contrast sclerosis artifacts in the superior vena cava and the enhancement CT values of the pulmonary artery trunks and the left and the right pulmonary veins.The extravasation of the contrast agent was recorded for the patients in the 2 groups.SPSS 25.0 software was used for statistical analysis.Results The two groups had no significant differences in score pulmonary artery CTA image quality(P＞0.05);the experimental group had the socre of contrast sclerosis artifacts in the superior vena cava statistically lower than that of the control group(P＜0.05).The two groups had no obvious differences in the CT values of the pulmonary artery trunks and the left and the right pulmonary veins(P＞0.05).There were no patients with the extravasation of the contrast agent found in the experimental group,while there one case with severe extravasation and 4 cases with mild or moderate extravasation in the control group.Conclusion Low-flow rate and-contrast injection scheme for pulmonary artery CTA of the elderly patients contributes to avoiding contrast agent extrava-sation while ensuring image quality,enhancing patient experience and safety.[Chinese Medical Equipment Journal,2024,45(10):66-70]

This review presents the state of the art of pH-responsive polymeric micelles for cancer drug delivery. Solid tumors have a weakly acidic extracellular pH (pH < 7), and cancer cells have even more acidic pH in endosomes and lysosomes (pH 4-6). The pH-gradients in tumor can be explored for tumor targeting and drug release in cancer drug delivery by applying pH-responsive polymeric micelles. The pH-responsive polymeric micelles consist of a corona and a core, and are made of amphiphilic copolymers, in which there are pH-responsive polymeric blocks. Two types of pH-responsive polymers-protonizable polymers and acid-labile polymers have been mainly used to make pH-responsive micelles for drug delivery. The protonizable polymers are polybases or polyacids, and their water-soluble/insoluble or charge states undergo changes with the protonation or deprotonation stimulated by external acidity, while the acid-labile polymers change their physical properties by chemical reaction stimulated by the acidity. Polymeric micelles whose core or coronas respond to the tumor extracellular acidity can be explored for triggering the fast release of the carried drug, activating the targeting group and accelerating the endocytosis of drug-loaded polymeric micelles, and those whose core or coronas respond to the tumor lysosomal acidity can be used for facilitating their escape from the lysosomes and targeting the nucleus. Various in vivo and in vitro experiments demonstrated that pH-responsive polymeric micelles are effective for cellular targeting, internalization, fast drug release and nuclear localization, and hence enhancing the therapeutic efficacy and reducing the side effect of cancer chemical therapy.
Antineoplastic Agents ; administration & dosage ; therapeutic use ; Drug Delivery Systems ; Humans ; Hydrogen-Ion Concentration ; Micelles ; Nanoparticles ; Neoplasms ; drug therapy ; Polymers ; chemistry

OBJECTIVETo observe the effect of electroacupuncture (EA) on cytokines in the cardiac surgical patient and to evaluate the application of combined acupuncture anesthesia to cardiac surgery.

METHODSThirty patients with atrial septal defect were divided into 3 groups, general anesthesia group (A), acupuncture anesthesia group (B) and combined general anesthesia and EA group (C). Peripheral blood samples were collected before anesthesia, before cardiopulmonary bypass (CPB), 30 min after CPB and 24 h after operation to determine the levels of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), IL-6 and IL-10.

RESULTSThe levels of IFN-gamma and IL-2 decreased in the 3 groups after CPB and further decreased 24 h after operation, and in the group C were higher than those in the group B. The levels of IL-6 and IL-10 significantly increased 24 h after operation in the 3 groups with no significant difference among the 3 groups.

CONCLUSIONThe general anesthesia combined with EA can not completely improve the decrease of IFN-gamma and IL-2 induced by CPB, indicating that the good response of the general anesthesia combined with EA to stress can partially improve the immunosupression induced by CPB. Acupuncture does not have significant effect on inflammatory cytokine reaction induced by cardiac surgery.

Acupuncture Analgesia ; Adult ; Cardiac Surgical Procedures ; Electroacupuncture ; Female ; Humans ; Interferon-gamma ; blood ; Interleukin-10 ; blood ; Interleukin-2 ; blood ; Interleukin-6 ; blood ; Male ; Middle Aged

Objective To develop a teaching and examination system based on Delphi for the obstetric nurse. Methods The teaching materials were collected for the obstetric nurse, the teaching and examination mode was analyzed, and Delphi was used for programming and MySQL database was applied to teaching and examination data. Results The system had easy operation, high stability and rapid response to the database, and could meet the requirements for the teaching and examination of the trainee nurse. Conclusion The system realizes informatization and high expansibility of obstetric teaching and examination, and thus is worthy promoting practically.

Objective To observe the effect of home care nursing guidelines based on care protocol nursing theory on hemodialysis(HD)patient compliance of ingesting liquid.Methods Forty-eight HD cases were randomized into Groups A(the observation group,n = 24)and B(the control group,n = 24).The control group was given usual care and health education,and the observation group was additionally cared with home care nursing based on care protocol nursing theory for 1 month and followed up for 3 months.The compliance of ingesting liquid was evaluated and the relation between the family supporting and the IDGW relative magnitude (IDGW)was obversed.Results The IDGW relative magnitude of the observation group was lower than the control group;the compliance of ingesting liquid was more improved in the observation group;the level of family supporting of the observation group was obviously higher than the control group;and it was a negative correlation between the family supporting and the IDGW relative magnitude.Conclusions Home care nursing based on care protocol nursing theory makes patients get family support from their family that got guidelines,increase the compliance of ingesting liquid,and control IDGW during hemedialysis in an ideal range,