Objective To investigate the effectiveness of different dose dexmedetomidine ( DEX) combined with video laryngoscopy during orotracheal Intubation for patients with spontaneous breathing. Methods A total of 87 emergency or intensive care unit ( ICU) patients with spontaneous breathing was in-cluded (age range:18 to 75 years).The patients were randomly divided into three groups with 29 cases each:midazolam combined with fentanyl group ( A) , low dose DEX group ( B) , and high dose DEX group (C).Mean arterial pressure (MAP),heart rate (HR), and SpO2 were detected before injecting different dosage drugs (T0), during intubation (T1),after intubation immediately (T2), at 3 min after intubation ( T3 ) .The amount of intubation time and side effects in each group were assessed.Results Compared to A group, the changes of hemodynamics in group B and C were more stable after injecting drugs.The doctors spend less time for intubation in group B and C.The rate of significant bradycardia in group C was higher than other groups.Conclusions If you can assess indications, doses and timings strictly, it was safety and availability to control intubation response in the patients with spontaneous breathing by injected of DEX.

OBJECTIVE:To improve the work quality in Pharmacy intravenous admixture service(PIVAS). METHODS:The major working links of PIVAS(labeling and drug admixture)were optimized,the work efficiency and error before and after optimi-zation were compared. RESULTS:The work efficiency was improved and error was decreased by adding logo and adjusting work range of personnel when labeling and improving distribution principles of drugs to be allocated in horizontal laminar flow table when drug admixture;compared with before,the labeling time for each bag decreased from(2.69±0.17)s to(2.19±0.08)s,to-tal time for admixture decreased from (104 ± 2) min to (83 ± 2) min,error rate of drug admixture decreased from 0.34% to 0.16%. CONCLUSIONS:The optimized work flow had improved the work quality of PIVAS.

The reform in cultivating professional-degree programs in Clinical Medicine Education contributes to the transformation of training mode, which surpasses the connotative bounds of the inherent education management. The personalized training of students has made it more challenging for both the tutor and the faculty to involve in education management, the effectiveness of which is highly valued due to the pressing need for sound medical ethics. Furthermore, the development of information technology calls for the reform of education management as well as the emphasis of student-centered approach. This article summa-rizes the existing problems of current education management mode for master degree programs of profes-sional clinical medical education. In addition, a three-level management system composed of medical experts is brewed and put forth. This system, based on compensation and restraint, assessment and incentive, ser-vice as well as security, is meant to facilitate the training of application-oriented medical talents.

Objective To investigate the role and mechanism of signal transducer and activator of transcription 4 (STAT4) in homocysteine (Hcy)-induced proliferation,migration and senescence of human aorta smooth muscle cells (VSMCs).Methods After VSMCs were incubated with Hcy (0-0.50 mmol/L) for various time periods,a CCK-8 assay was performed to determine proliferation activity.Modified Boyden chamber system (Transwell apparatus) was used to examine migration ability.A SA-β-gal staining kit was used to determine senescence status.Western blotting was performed to examine the expressions of STAT4 and phosphorylated STAT4 (p-STAT4) proteins,and ELISA was performed to examine MCP-1 expression.Results Hcy (from 0.05 mmol/L) significantly increased the proliferation of VSMCs (P ＜ 0.05).Hcy (from 0.10 mmol/L) significantly increased the migration of VSMCs (P ＜ 0.05).Hcy promoted the senescence of VSMC in a concentration-dependent manner,and significantly increased VSMC senescence when the concentration of Hcy reached 0.10 mmol/L (P ＜ 0.05).Hcy (from 0.10 mmol/L) treatment significantly increased the expression of p-STAT4 (P ＜ 0.05) and MCP-1 (P ＜ 0.05).Conclusions Hcy increases the proliferation,migration and senescence of VSMCs,probably by the activation of STAT4 pathway.

MicroRNA (miRNA) are a class of endogenous single -stranded non-coding RNA, which regulate gene expression post-transcriptionally by combining with the target mRNA and play a vital role in biological and pathological processes including the growth of organism , metabolic regulation, disease prediction and intervention.Thus miRNA detection is of considerable significance in disease diagnosis and the research of miRNA function.Because of the restriction factors about miRNA itself such as short sequence, low abundance and highly homologous , traditional methods for miRNA detection cannot meet the current demands due to the limitations like unsatisfactory sensitivity and complicated operation .This review summarizes the newly development about signal amplification -based methods for miRNA, including the advantages and limitations of all kinds of novel methods , and highlights the future trends as well.

Objective To investigate the protective effect and possible mechanisms of erythropoietin (EPO) on myocardial ischemia-reperfusion injury(MIRI) in rats.Methods Ninety male SD rats were randomly divided into three groups,the sham operation group (n =20),I/RI group (n =20),and EPO treatment combined I/RI group (n =20).The left anterior descending coronary artery was ligated for 30min utes and then loosed for 150min utes to establish the rat model of MIRI.Rats of EPO + I/RI group were injected with EPO(5000u/kg) in abdominal cavity,the others were injected with nomal sodium.The serum MDA content was determined in a method of the thiobarbituric (TBA),the cardiac injury markers(cTn Ⅰ,CK,CK-MB) contents were determined by ELISA.Results The serum MDA and MPO levels of the I/RI group were significantly higher than the sham group,difference was significant(t =10.445,9.848,all P ＜ 0.05) ; Intervention by EPO,the serum MDA and MPO levels of the EPO + I/RI group were significantly lower than the I/RI group,the difference was significant (t =5.087,6.683,all P ＜ 0.05).The serum cTn Ⅰ,CK and CK-MB levels of the I/RI group were significantly higher than the sham group,the difference was significant (t =8.153,5.411,3.729,P ＜ 0.05) ; Intervention by EPO,the serum cTn Ⅰ,CK and CK-MB levels of the EPO+ I/RI group were significantly lower than the I/RI group,the difference was significant(t =4.808,4.089,3.002,all P ＜0.05).Conclusion EPO has protective effect on MIRI,the effect may be through EPO's antioxidant,antiinflammatory and protective effect on myocardial cells in the MIRI rats.

Objective To invent a set of novel veno-venous bypass (VVB) device based on magnetic anastomosis technique which can be used in ex situ liver resection, and verify its clinical value and performance in animal models.Methods Each VVB device was constructed using three magnetic rings and an inverted Y-shaped tube with magnetic rings on each end.The magnetic ring was made of NdFeB with electrode cutting, and the tube was made of polyvinyl chloride (PVC) and preconditioned with heparin coating on the surface of the lumen.Ten dogs underwent the ex situ liver resection, and VVB was established via magnetic anastomosis technique with the novel VVB device during the operation.The time for completing VVB was recorded, and the hemodynamic indexes including the venous flow velocity, carotid pressure, central venous pressure and portal pressure was detected.The changes of intestinal lumen and kidney were also observed.Results It only took 6 ～ 10 minutes to establish VVB by the novel VVB device in the operation,and the hemodynamics stability was maintained smoothly during the anheptic phase.The shunt index of inferior vena cava and portal vein was 76.2％ and 75.5％, respectively.The congestion of intestinal canal and kidney were also alleviated during the anheptic phase.Conclusions It could reduce the time to establish VVB with magnetic anastomosis technique in ex situ liver resection.This study showed that utilizing the novel VVB device for intraabdominal VVB during the anheptic phase could be helpful to maintain the hemodynamics stability.

Objective To investigate the triggering receptor expressed on myeloid cells-1(TREM-1) of cord blood leukocytes in neonates and the transcription level of mRNA, and analyze its promoting function of inflammatory cytokine secretion. Methods During the period from September 2013 to March 2014, cord blood was collected from 20 term neonates at the time of birth, and peripheral blood was collected from 20 healthy adults. The expression of TREM-1 and TREM-1 mRNA on leukocytes was observed using flow cytometry and real-time reverse transeription-polymerase chain reaction, respectively. After the whole cord blood was stimulated by lipopolysaccharide (LPS) or LP17 plus LPS, the contents of interleukin (IL)-6, tumor necrosis factor-α (TNF-α), IL-8 and soluble TREM-1 (sTREM-1) in the supernatant were analyzed by enzyme linked immunosorbent assay. The statistical significance was determined using the one-way ANOVA test, t test, q test and Pearson correlation coefficient. Results The mean fluorescence intensity of TREM-1 on leukocytes of newborns was not different compared with healthy adults (P>0.05), while the percentage of TREM-1 positive on polymorphonuclear cells was lower than that of healthy adults [(82.3±7.1)% vs (98.6±4.8)%, P<0.05]. The level of TREM-1 mRNA in newborns was lower than in healthy adults (1.16±0.13 vs 1.63±0.24, t=7.714, P<0.01). The LPS treatment significantly increased sTREM-1 in newborn whole blood compared with the control treatment [(156.7±36.3) vs (34.6±6.1) pg/ml, t=13.623, P<0.01]. The concentration of IL-6, TNF-αand IL-8 decreased significantly when TREM-1 was blocked by LP17. In addition, the concentration of sTREM-1 showed a positive correlation with the levels of TNF-α(r=0.519, P<0.05), IL-6 (r=0.507, P<0.05) and IL-8 (r=0.538, P<0.05). Conclusions Healthy newborns exhibit expression of TREM-1 on monocytes similar to healthy adults, and most PMNs express TREM-1 at the newborn stage. Blocking the TREM-1 signal transduction pathway may reduce inflammatory responses of neonate leukocytes.

Objective To study the role of risk factors associated with hemodynamics in patients with intracranial artery stenosis.Methods Eighteen patients with local stenosis of middle cerebral artery were recruited in this study retrospectively.According to patients′clinical symptoms and magnetic resonance imaging findings, they were divided into the symptomatic group (n=13) and the asymptomatic group (n=5).Wall shear stress ( WSS) , oscillatory shear index ( OSI) , velocity and pressure of the stenotic artery wall were compared between the two groups after reconstructing 3-dimentional model of hemodynamics.Then related risk factors of hemodynamics were analyzed in symptomatic intracranial atherosclerotic stenosis.Results There were no statistically significant differences between the two groups in the parameters such as age, sex, degree of artery stenosis, mean arterial pressure and some medical histories of hypertension and diabetes.The results showed obvious changes of hemodynamics in local artery stenosis.The WSS(78.69(68.15,117.65) Pa vs 39.34(22.76,60.54) Pa,U=4,P=0.003), pressure of the stenotic artery wall (1 815.14(1 242.44,4 398.84) Pa vs 735.55(361.17,1 528.78) Pa,U =7,P=0.010)and velocity of the local stenosis(3.87(2.58, 4.52) m/s vs 2.31(1.38,3.12) m/s,U=12,P=0.046) in the symptomatic group were much higher than those in the asymptomatic group; however, there were no significant differences between the two groups in OSI.Conclusions Hemodynamic features do exist in local intracranial atherosclerotic stenosis.The WSS, wall pressure and velocity of the local stenosis may be vital risk factors associated with symptomatic intracranial atherosclerotic stenosis.

Objective To explore the effects of family empowerment model on medication adherence in youth patient with cerebral infarction.Methods By convenience sampling,a questionnaire survey was conducted among 84 patients and families of neurology department in a third-grade and a-level general hospital in Zhengzhou.The patients and families were randomly divided into the control group and the intervention group,each group consisted of 42 patients and families.Patients and families in the control group got routine health education,but patients and families in the intervention group were intervened under family empowerment.The medication adherence of the patients were compared between the two groups before and after health education.Results The medication adherence in both groups were higher after health education than that before health education,the diffidence in the comparison of medication adherence was statistically significant between the two groups after health education.Conclusions The family empowerment model can improve the medication adherence in youth patient with cerebral infarction.