With the population ageing, the number of elderly patients with end-stage renal disease(ESRD)is increasing, and the proportion of elderly patients undergoing hemodialysis is also increasing year by year.The elderly patients undergoing hemodialysis are susceptible to frailty due to the comorbidities, polypharmacy, chronic inflammation, malnutrition and other factors.In addition, frailty can lead to a variety of adverse prognosis such as falls, fractures, cognitive decline, all-cause hospital readmissions and all-cause death in elderly patients undergoing hemodialysis.

Objective To investigate the clinical effects of continuous 3-in-1 femoral nerve block with stimulating catheters for patient controlled regional anesthesia(PCRA) in elderly patients after unilateral total knee replacement (TKR)surgery.Methods Thirty ASA Ⅰ - Ⅱ elderly patients wererandomly divided into two groups: FB group and Ⅳ group.FB group received continuous 3-in-1 femoral nerve block for postoperative analgesia with 0.2% ropivacaine plus 0.1 μg/ml sufentanil continuous infusion at 5 ml/h plus PCA boluses (1.0 ml/15 min).Ⅳ group received continuous intravenous analgesia with 1 μg/ml sufentanil plus 0.04 mg/ml tropisetron hydrochloride at 2 ml/h plus PCA boluses (0.5 ml/15 min).All patients were maintained analgesia for 48 hours.Results In FB group, the visual analogue scale(VAS) scores were 1.3 ±1.1, 1.2 ± 1.0, 1.1±0.9, 1.1 ± 1.0,1.0±0.9 at 4, 8, 12, 24, 48 hours after surgery under rest status respectively and were 3.04±1.4,2.3±1.3 at 24, 48 hours after surgery in active function training.These parameters in Ⅳ group were 4.0±1.6, 3.5±1.6, 3.2±1.4, 3.0±1.3, 2.5±1.2, 4.7±1.5 and 3.3±1.5 respectively, which were significantly different compared with FB group (t=5.358, 4.707, 4.852, 3.784, 3.743, 3.254,1.932,all P<0.05 or P<0.01).The incidence of nausea was higher in IV group than in FB group(P = 0.0022).Postoperative satisfaction ratings was higher (χ2 =41.1 ,P<0.01) and the total morphine use for 48 hours after operation was less(uc=2.412, P<0.01) in FB group than in Ⅳ group.Conclusions After TKR surgery, the continuous 3-in-1 femoral nerve block with stimulating catheters is an effective method with better pain relief,fewer side effects and higher satisfaction ratings in the elderly.

Objective To appraise the diagnosis value of pleural membrane biopsy on pleural effussion.Meth- ods 218 patients with pleural effusion who were had pleual menbrane biopsy were retrospectively analyzed.Among them 165 cases were done only once,42 cases were done twice,11 cases were done three times.They were done 271 times of biopsies.Results The pleural membrane biopsy always masculine gender rate was 72.0%,1 pleural mem- brane biopsy succeeds the masculine gender rate was 59.6%,after the masculine gender rate which 2 pleural mem- branes biopsies succeeds was 69.7%.The illness complication formation rate was 8.7%.Conclusion Pleural mem- brane biopsy is a simply,safe and higher diagnosing-rate method.The different spot pleural membrane biopsy may cnhance diagnosis rate.

Adult ; Dust ; analysis ; Female ; Humans ; Male ; Middle Aged ; Neural Networks (Computer) ; Occupational Exposure ; Silicosis ; diagnosis ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; methods

Adipose Tissue ; cytology ; physiology ; Animals ; Humans ; Leptin ; physiology ; Stromal Cells ; physiology

Objective To evaluate the significance of standardized ultrasound examination of fetal structures in the ifrst trimester (11-13+6 weeks). Methods The ultrasound data of 29 858 fetuses who underwent the ifrst trimester screening were analyzed retrospectively in Beijing Obstetrics and Gynecology Hospital of Capital Medical University from January 2010 to December 2012 and followed up the cases with structural abnormalities and increased nuchal translucency (NT). Results Among 29 858 fetuses, 328 structural defects were detected in 284 fetuses (0.95%) by ultrasound in the first trimester, including fetal hydrops (124 cases), choroid plexus cysts (36 cases), exencephaly (32 cases), gastroschisis (24 cases), exomphalos (22 cases), cardiac defects (19 cases), megacystis (14 cases), spine abnormalities (10 cases), meningoceles/encephaloceles (9 cases), alobar holoprosencephaly (8 cases), hydrocephaly (7 cases), abnormalities of extremities (7 cases), acrania (6 cases), amniotic band syndrome (4 cases), abdominal cyst (3 cases) and conjoined twins (3 cases). Pregnancy was terminated in all cases (115) with exencephaly, gastroschisis, exomphalos, meningoceles/encephaloceles, alobar holoprosencephaly, hydrocephaly,abnormalities of extremities, acrania, amniotic band syndrome and conjoined twins, and the defects were verified by the gross appearance of fetuses. Two cases of megacystis were turned out to be normal during follow-up while 1 case was proved to be aneuploid and 1 other case progressed to multiple abnormalities during the second trimester. Most choroid plexus cysts, except 1 case of aneuploid, were normal during the second and the third trimester follow-ups by ultrasound. Thirteen cases of fetal hydrops were found to be aneuploids and 4 hydrops cases were proved to be complicated with other structural defects during the second and the third trimester. NT was increased in 422 cases (1.41%), among which 122 cases (28.91%) were complicated with structural defects and/or fetal hydrops. Ninty-nine cases with increased NT underwent chromosomal examination and 38 cases were found to be aneuploides. During the follow-up of 298 cases with increased NT who continued pregnancy, 21 structural abnormalities were found, including cardiac defects (14 cases), neural abnormalities (4 cases) and diaphragmatic hernia (3 cases). Conclusion The standardized fetal ultrasound in the first trimester is a effective tool for the screening of aneupolides and major structural abnormalities.

An HPLC method has been developed to determine polydatin in giant knotweed rhizome. In order to systematically validate the method, specificity, precision, linearity of reference solution and test solution, repeatability, reproducibility, accuracy, stability and robustness were measured. In the robustness test, a one-variable-at-a-time procedure was applied to evaluate the influence of slight variations in method factors, including the flow rate, the column temperature, the extraction time, and etc., on the assay result of polydatin. No significant differences were found when the process parameters changed during the experimental domain. And system suitability test limits were defined based on the robustness test. Results showed that the developed method was accurate, reproducible and robust.

This paper analyzed the main problems confronting support-type emergency management in general hospitals,introduced the experience and effect to strengthen the management of emergency key diseases in the hospital.The efficiency and success can be improved by implementation of institutionalized and routing management,emergency plan management based on the key diseases and strengthening the information construction and management.

The problems to offer HIS course in plateau medical colleges and universities were pointed out and corresponding reform measures were put forward in view of the requirement for medical professionals in the 21stcentury information society and the current situation in HIS course teaching.

Tetrabromobisphenol A(TBBPA)is supposed to have potential thyroid disrupting activities due to its similar structure to thyroid hormones.TBBPA has been proved to show thyroid disrupting effects in vivo and in vitro studies.TBBPA might disrupt thyroid hormone system through transthyretin- and thyroid receptor-mediated pathways.The ability of TBBPA inducing the production of reactive oxygen species might be the extension of its thyroid disrupting activities.The thyroid disrupting effects of TBBPA might be closely related to its oxidative stress,reproduction toxicity and neurotoxicity.More experiments are required for the effects of TBBPA on the aquatic and amphibian animals.