Objective To evaluate development of gastro-esophageal reflux (GER) during laparoscopic surgery in lateral jack-knife position under general anesthesia through comparing with reverse Trendelenburg/ Trendelenburg position in the patients lying supine.Methods Ninety patients of both sexes,aged 18-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index of 18-30 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were randomly divided into 3 groups (n =30 each):lateral jack-knife position group (group L),Trendelenburg position group (group T) and reverse Trendelenburg position group (group Tre).Anesthesia was induced with midazolam,sufentanil,propofol and cisatracurium besylate and maintained with propofol and remifentanil given by target-controlled infusion.A pH-sensitive probe was inserted through nose into the lower esophagus and pH value was continuously recorded until 1 min after extubation.GER was defined as pH value ≤ 4 lasting for ≥ 1 min in the lower esophagus during surgery.The development of GER during surgery and the lowest pH value in the lower esophagus when GER developed were recorded.Results Compared with group Tre,the incidence of GER (27％) and total number of times GER had occurred were significantly increased in group L,and no significant changes were found in the indices mentioned above in L and T groups.When GER developed,the lowest pH value in the lower esophagus was 2.1 ± 1.3,2.6 ± 1.2 and 3.5 in L,T and Tre groups,respectively.Conclusion The incidence of GER is 27 ％ during laparoscopic surgery when the patients are in lateral jack-knife position and it is higher than that obtained with reverse Trendelenburg position in the patients lying supine.

OBJECTIVE:To compare the contents of loganic acid,swertiamarin,6′-O-β-D-glucosyl gentiopicroside,gentiopi-croside,sweroside,isoorientin and isovitexin in wild and cultivated Gentiana officinalis,and to provide basis for rational use of G. officinalis. METHODS:UPLC method was adopted. The separation was performed on ACQUITY UPLC? BEH C18 column (50 mm × 2.1 mm,1.7 μm) with mobile phase consisted of methanol-0.04% phosphoric acid (gradient elution) at the flow rate of 0.3 ml/min. The detection wavelength was set at 242 nm,and column temperature was 30 ℃. RESULTS:For loganic acid,swertiama-rin,6′-O-β- D-glucosyl gentiopicroside,gentiopicroside,sweroside,isoorientin and isovitexin,a good linearity was obtained in the range of 2.1-537.1 μg,1.05-270 μg,0.92-236 μg,11.1-2 830 μg,0.75-192 μg,0.167-102 μg,0.216-52.80 μg(r≥0.999 5), respectively. Their average recoveries were 97.72%-99.84%(RSD≤3.39%,n=6). The contents of loganic acid,swertiamarin, 6′-O-β-D-glucosyl gentiopicroside,gentiopicroside,sweroside and isoorientin in the wild sample were higher than in the cultivat-ed;the content of isovitexin was lower than the cultivated,but there was no statistical significance(P>0.05). The sum of gentiopi-croside and loganin acid content were all higher than 2.5% in both wild and cultivated samples,and met the requirements of 2015 edition of Chinese Pharmacopoeia(first part). CONCLUSIONS:The content difference of 7 indicative constituents in wild and cul-tivated G. officinalis is not statistically significant,and the indicative constituents of the pharmacopoeia is qualified.

Isothermal nucleic acid amplifications, as powerful as polymerase chain reaction but functioning at a constant temperature, are considered to be very promising technique in achieving point-of-care gene diagnostics. However, until now, their practical applications are still seriously lagged by the bad reliability resulting from the problems such as false positive amplification and low signal amplitude. In this work, a universal transduction method in which any sequence ( including loop-mediated isothermal amplification products) could be transduced via a hairpin transducer into a catalyst of a well-engineered circuit (catalytic hairpin assembly, CHA) was established. Because CHA circuit could amplify tens to hundreds fold with especially high sequence specificity, it could provide both accuracy and high amplitude for sequence detection. And for a new targeting sequence, the only sequence needed to be changed was the hairpin transducer. Due to the importance of the transducer, we provided and verified a universal designing rule-set to guarantee the transducing efficiency ( signal to background ratio) of the transducer. Transducers designed following this rule set were then proved to be very efficient in detecting pathogen gene targets. As less as near single molecule ( 20 copies ) of pathogen genes could be detected with significant fluorescent and electrochemical signals.

Objective Toinvestigatetheeffectofmicroribonucleicacid(miRNA)-155ontwo subtypesofregulatoryTcell(Treg):inducedTreg(iTreg)andnaturalTreg(nTreg).Methods NaveT cells and nTreg were isolated from peripheral blood mononuclear cell (PBMC)of healthy donors by magnetic cell sorting. Cells were divided into 3 groups during culture,including control group (nave T cells were cultured with the presence of interleukin-2 ),iTreg group (nave T cells were cultured with the presence of interleukin-2 and transforming growth factor-β)and nTreg group(nTreg cells was cultured with interleukin-2).Each group was divided into 3 subgroups (none,scramble or miRNA-155 antagomir subgroup,3 wells in each subgroup). Expression level of miRNA-155 gene of none subgroup in 3 groups was detected by low density chip analysis method. The levels of surface marker CD25,Foxp3,CD127 of each subgroup in 3 groups were detected by flow cytometry. The percentage of CD4 +CD25 +Foxp3 +SOCS1 +Treg and suppressive function of Tregofeachsubgroupin3groupswerealsodetectedbyflowcytometry.Results Comparedwithcontrolgroup and iTreg group,the expression level of miRNA-155 was significantly lower and SOCS1 was significantly higher in nTreg group (all in P<0.05 ). After the addition of miRNA-155 antagomir,no significant change was observed in the important surface markers of Treg like Foxp3,CD25,CD127. Compared with control group and iTreg group,the expression of SOCS1 in nTreg group increased significantly (both in P <0.05 ). The expression level of miRNA-155 of none subgroup in iTreg group was lower. The expression of SOCS1 increased after the miRNA-155 was inhibited by antagomir (miRNA-155 antagomir subgroup). In iTreg group,the suppressive function of Treg in miRNA-155 antagomir subgroup was higher than that in none subgroup at the ratioof1∶8,1∶16and1∶32(allinP<0.05).Conclusions AntagonismofmiRNA-155invitrohasno significant effect on the suppression function of nTreg,but can increase the SOCS1 expression level and suppression in vitro of iTreg.

Objective To explore the impact of fast-track surgery (FTS)on prognosis of liver transplant patients.Methods Inclusion criterias:(1 )primary disease was cirrhosis or primary liver cancer meeting Milan criteria;(2)surgical method was modified piggyback orthotopic liver transplantation (OLT);(3)no liver transplantation operation was performed before.Exclusion criterias:(1 )age ≤ 1 6 years old;(2)receiving OLT more than 1 time;(3)transcatheter hepatic arterial chemoembolization or radiofrequency ablation was performed before or during operation.From January 201 1 to December 201 3 in First Affiliated Hospital of Nanjing Medical University,52 patients meeting the criteria above were enrolled into this prospective random single-blinded study (all operations were performed by same team) .According to different peri-operative managements,they were divided into FTS group (n =21 )and non-FTS (NFTS)group (n =31 ).Protocol of FTS included comprehensive pre-operative education,no bowel preparation,no usage of nasogastric tube pre-operation and surgical drainage post-operation,prevention of hypothermic during operation, smaller incision,early exercise and enhanced oral nutrition. Intra-and post-operative parameters were compared between 2 groups.Step-by-step Logistic regression was used to evaluate relationship between FTS and clinical parameters,in order to analyze the impact of FTS on the prognosis of liver transplantation.Results Compared with NFTS group,operation time and anhepatic phase time decreased significantly in FTS group,as well as intra-operative bleeding and transfusion (all in P <0.05).Besides,intensive care unit (ICU)days and total length of stay in FTS group were shorter than those in NFTS group,which indicated a better prognosis of patients in FTS group (both in P <0.05 ).Logistic regression suggested that FTS management was a favorable factor of shortening ICU days (odds ratio:0.301 ,95% confidence interval:0.1 84-0.494,P =0.000)and total length of stay (odds ratio:0.1 48,95% confidence interval:0.085-0.257,P =0.000).Conclusions Application of FTS in perioperative period can improve the prognosis of liver transplant patients.

Objective:To observe the effect of oral-facial muscle training applying virtual reality technology (VR) and of action observation therapy on the salivation of children with cerebral palsy (CP).Methods:Sixty CP children with uncontrolled salivation were randomly divided into a control group and an observation group, each of 30. In addition to conventional rehabilitation treatment, the control group received routine tongue muscle training, buccal lip muscle training, ice stimulation, and Masako swallowing training. The observation group received oral-facial muscle training based on action observation therapy in a virtual environment. Both groups were trained 30min per day, 5 times a week for 3 weeks. Before and after the treatment, drooling (DDSS) and swallowing function scores were evaluated. Integrated surface electromyography (iEMG) of the buccinator and orbicularis oris muscles was also performed.Results:After treatment, a significant decrease was observed in the average DDSS and the swallowing function scores of both the control and observation groups, along with a significant increase in the average root mean square values of the buccinator and orbicularis oris iEMGs of both groups. However, the average DDSS score of the observation group was significantly lower than that of the control group, while the average iEMG readings were significantly better.Conclusion:VR-based action observation oral-facial muscle training is a more effective supplement to conventional rehabilitation treatment than conventional oral-facial muscle training in improving the salivation of children with CP.

ABSTRACT:OBJECTIVE To observe the differences of curative effect among superficial needle therapy,Xiakucao oral solu-tion and Vitamin E soft capsules on the breast tenderness caused by mammary glands hyperplasia and to explore the optimum therapeutic method.METHODS 105 patients with mammary glands hyperplasia were randomly divided into the superficial needling group,the Xiakucao group and the Vitamin E group,with 35 cases in every group.Patients in the superficial needling group were treated with the superficial needling retaining for 5 hours.Patients in the Xiakucao group and the Vitamin E group took medicine with oral administration.Treatment in the three groups all began from 7 ± 3 days before menstruation and stopped during menstruation.The superficial needling group was treated once every other day with total 3 times.Patients in the Xiakucao group took medicine twice a day in the morning and evening.The Vitamin E group was treated once a day.Com-pare the scores of short form McGill pain Questionnaire(SF-MPQ) before and after the treatment and after one month follow-up.Record the time needed for pain relieving in the first treatment of the superficial needling group and the adverse effects in the three groups.RESULTS After the treatment,the breast tenderness was improved obviously in the three groups (P <0.01)and the superficial needling group was superior to the other groups(P <0.01).During the one-month follow up,the su-perficial needling group showed good effects(P <0.01).It also showed fast effect on relieving the pain in the first treatment. The Xiakucao group was superior to the Vitamin E group in the improvement of the breast tenderness(P <0.05).CONCLU-SION The superficial needling therapy shows fast and lasting effects on relieving the pain of mammary glands hyperplasia, which is superior to Xiakucao oral solution and Vitamin E soft capsules.

The management of clinical application of antimicrobial drugs is an important part of the pharmaceutical management and pharmacy services in medical institutions.Based on national policies and regulations,this standard focuses on the whole life cycle of antimicrobial drugs in medical institutions.It is developed based on the principles of scientific validity,universality,guidance and operability,formed by sorting out problems,collecting opinions,expert argumentation and deliberation.It is the first group standard to standardize the clinical application management of antimicrobial drugs.This paper introduces and analyzes the team composition,problem sorting and compilation process,and various elements of the standard in the process of formulating the standard,and provide a reference for the majority of peers who use it.

Objective To evaluate the status and trend of direct economic burden on cerebrovascular disease,from 1993 to 2008 in China.Methods Using two-step model to calculate the economic cost with related trend of cerebrovascular disease within the population among the over 30-year-olds,from 1993 to 2008.Data was gathered from the National Health Service Surveys Analysis Reports of 1993,1998,2003 and 2008,that including both direct outpatient and inpatient cost.Results There appeared a significant increase on the burden of cerebrovascular diseases in the period of 15 years,with direct economic cost increasing from 8.473 billion to 103.125 billion RMB.In fact,the actual increase was 5.3 times,without the influence of the price.The average annual growth rate was 13.1％,exceeding the rate of total expenditure on health and GDP during the same time span.In addition,the growth rate in 2003-2008 was the fastest,which appeared to be 19.8％.Conclusion Burden that caused by cerebrovascular disease on individuals and the whole society was heavy which warrented further theoratical and practical studies on it.

Off-label use means that the intended use of the drug is not included in the instructions approved by the National Medical Products Administration,including unapproved indication,dosage,the course of treatment,route of administration,or population.The formulation of Pharmaceutical Supply Services-Key Medications Management-Off-label Uses is based on relevant laws,regulations,normative documents,guidelines,literatures,and expert opinions,and follows the principles of scientificity,versatility,instructiveness,and operability.This standard regulates and standardizes the institutional and organizational construction,process management,and the whole process of quality management and evaluation improvement of off-label uses,which is the basis for medical institutions to carry out off-label uses management.This article introduced the formulation process of the off-label uses standard and analyzed the key contents of the standard,which would help medical institutions to better comply with and meet the requirements of this standard in the practice of off-label use management.