Eleven elderly patients undergoing maintenance hemodialysis without ARB or ACEI within 4 weeks were enrolled. Anti-hypertensive agents were replaced by telmisartan gradually to maintain stable blood pressure. Before and after 6 or 12 weeks of treatment, blood biochemical profiles, fasting blood glucose, fasting plasma insulin, insulin resistance index(HOMA-IR), blood pressure, and body weight were recorded. Our results showed that telmisartan did not affect body weight, high-density lipoprotein (HDL), triglyceride (TG), SCr, BUN, Alb, K+ , and PTH, although led to a significant decrease in TC and low-density lipoprotein (LDL). Following telmisartan treatment, FPG did not change significantly, but fasting insulin decreased from 13.9±3.6 mU/ml to 9.9±2.7 or 9.1±2.3 mU/ml at 6 and 12 week (P<0.01), and HOMA-IR decreased from 3.5±1.4 to 2.4±0.8 or 2.2±0.8 at 6 and 12 week (P<0.05). These results suggest that insulin resistance in elderly patients with MHD may be improved by telmisartan.

Objective To evaluate the analgesic effect of dexmedetomidine on the ultrasonic guidance brachial plexus block.Methods Sixty patients who underwent elective for one-side upper limb or forearm surgery were selected,they were received ultrasonic guidance brachial plexus block.The patients were divided into observation group and control group by random digits table method with 30 cases each.The observation group received 0.5％ ropivacaine 100 mg and dexmedetomidine 0.75 μg/kg,and the control group received 0.5％ ropivacaine 100 mg alone.The heart rate,mean arterial pressure (MAP),pulse oxygen saturation (SpO2) at the time of entering operating room,brachial plexus block completed,incision and the end of surgery were recorded.After brachial plexus block completed,the visual analogue score (VAS) at the time of incision,1 h during surgery and 1,2,6,12,24,48 h after surgery was recorded.Morphine was given the patients when VAS ＞ 4 scores,and the time to first prescription of morphine and total morphine consumption dose within 48 h after surgery were also detected.The adverse reaction was recorded.Results There were no statistical differences in heart rate and MAP at the time of entering operating room and brachial plexus block completed between the 2 groups (P ＞ 0.05).The heart rate and MAP at the time of incision and the end of surgery in observation group were significantly lower than those at the time of entering operating and the same time of control group,there were statistical differences (P ＜ 0.05).There was no statistical difference in SpO2 between the 2 groups (P ＞0.05).The VAS at the time of 6,12,24 and 48 h after surgery in observation group were significantly lower than those in control group [(3.0 ± 0.9) scores vs.(4.9 ± 0.5) scores,(3.0 ± 0.7) scores vs.(5.6 ± 1.2) scores,(2.2 ± 0.9) scores vs.(4.8 ± 1.8) scores,(1.7 ± 0.5) scores vs.(3.2 ± 1.0) scores],there were statistical differences (P ＜ 0.05).The time to first prescription of morphine in observation group was significantly longer than that in control group [(450 ± 37) min vs.(368 ± 42) min],the total morphine consumption dose was significantly lower than that in control group [(8.3 ± 2.8) mg vs.(15.5 ± 4.5) mg],there were statistical differences (P ＜ 0.05).There was no adverse reaction found.Conclusion Ropivacaine plus 0.75 μ g/kg dexmedetomidine for ultrasonic guidance brachial plexus block may prolong the duration of analgesia,thus reduce morphine consumption within 48 h after surgery without severe adverse reaction.

Objective To understand the clinical distribution of Acinetobacter baumannii and its resistance to commonly used an‐tibiotics so as to provide the theoretical basis for rational clinical use of antibacterial medicines .Methods The clinical distribution and drug resistance situation of 206 strains of clinically isolated Acinetobacter baumannii in the Anhua County People′s during 2012-2014 were analyzed .The bacterial identification was completed by the department of clinical laboratory ,the drug susceptibili‐ty test was performed by adopting the disk diffusion method ,and the detection results were judged according to CLSI 2012 criteria . Results A total of 2 803 strains of bacteria were isolated during 2012-2014 ,including 206 strains of Acinetobacter baumannii .Its constituent ratios during this period were 6 .71% ,6 .82% and 8 .19% ,showing the increasing trend year by year .The samples were mainly isolated from sputum (78 .16% ) ,followed by urine (7 .28% ) ,bronchoaleolar lavage fluid (6 .80% ) ,wound secretion (3 .40% ) and blood(2 .91% ) .The infected patients were mainly distributed in the respiratory department (40 .29% ) and neurosur‐gery department(22 .82% ) .The detection results of Acinetobacter baumannii showed the higher resistance to 20 kinds of commonly used antibacterial drugs ,in which the drugs with most significantly increase in 3‐year drug resistance rate were in turn ceftazidime , cotrimoxazole ,levofloxacin ,piperacillin and ciprofloxacin ,the 3‐year resistance rate to meropenem ,imipenem ,cefoperazone/sulbac‐tam and cefepime was less than 35% .Conclusion Acinetobacter baumannii is the major opportunistic pathogenic bacterium in noso‐comial infection with higher drug resistance rate .It is necessary to strengthen the monitoring of Acinetobacter baumannii drug re‐sistance and rationally use antibacterial medicines in order to stop the drug‐resistant strains colonization and cross expansion in hos‐pital .

Objective To investigate the effect of lectin like oxidized low density lipoprotein receptor 1 ( LOX-1 ) in NRK52E intaking lipid induced by oxidized low density lipoprotein ( ox-LDL). Methods NRK-52E was incubated with ox-LDL (0,25,50, and 100 g/ml ) for 24 hours or pre-treated with the chemical blocker of LOX-1 receptor- polyI or carrageenan, and then exposed to 50 μg/ml of ox-LDL. LOX-Ⅰ mRNA was examined by real-time PGR. LOX-1 protein was assessed by Western blot analysis. Lipid deposit was examined by oil red O. Results LOX-1 mRNA expression in 25,50,100 μg/ml ox-LDL group was 2. 13, 10. 14, 20. 81 times of that in 0 g/ml ox-LDL group ( P <0. 05 ,respectively). LOX-1 protein expression in 25,50,100 μg/ml ox-LDL group was 2. 53,12. 18,21.45 times of that in 0 μg/ml ox-LDL group( P <0. 05 ,respectively). Following the increased LOX-1, lipid intake increased. Pre-treatment with Poly Ⅰ or carrageenan, LOX-1 mRNA expression deceased by 48% or 47%, LOX-1 protein deceased by 72% or 65%, lipid intake induced by 41% or 49% ( P <0.05 ,respectively). Lipid had a close relationship with LOX-1 ( r = 0. 87, P < 0. 05). Conclusion Ox-LDL induced NRK52E to express LOX-1 and promoted NRK52E to intake lipid, and this effect could be partly blocked by LOX-1 blocker.

Objective To assess the effects of hyperventilation on the balance of cerebral oxygen supply and consumption during craniotomy Methods Twenty ASA Ⅰ Ⅱ patients with supratentorial tumor undergoing elective craniotomy were studied Anesthesia was induced with fentanyl 2 4 ?g/kg and propofol 1 2mg/kg I V and tracheal intubation was facilitated with succinylcholine 1 5 2 0mg/kg I V After tracheal intubation the patients were mechanically ventilated Anesthesia was maintained with isoflurane with or without nitrous oxide and intermittent intravenous bolus of vecuroinum The patients were randomly divided into two groups : in group Ⅰ anesthesia was maintained with 1 5% isoflurane alone (ISO group, n=10); in group Ⅱ with 0 8% isoflurane and 60% 65% N 2O(ISO N 2O group, n=10) Demographic data including age, sex and weight were not significantly different between the two groups In group Ⅰ there were 6 male and 4 female, the mean age was (40 1?9 7) years and weight (64 5?7 3)kg whereas in group Ⅱ there were 5 male and 5 female, mean age was(43 6?8 4)years and mean body weight (62 7?6 5)kg After the opening of dura mechanical ventilation was regulated to maintain PaCO 2 at 4 7 6 0kPa(normal ventilation), 0 9) Arterial and venous blood lactate was within normal range but had a tendency to increase Conclusions Severe hyperventilation influences the balance of cerebral oxygen supply and consumption significantly during either isoflurane or isoflurane N 2O anesthesia at equal MAC, particularly in ISO N 2O group Severe hyperventilation should not be used during anesthesia for brain surgery

Objective To evaluate the effect of vacuum suction on shaping sliming and breast anaplasty, to expand indications of vacuum suction, and to improve its result. Methods Based on injection of swelling solution more than routine dosage, vacuum suction was used in totally 825 cases, including local fat deposit in face or other sites of body, macromastia in female, hypermastia in male, lump after breast anaplasty by autograft of fat granule, as well as infection and induration after breast anaplasty by injection of polyacrylamide. Results Satisfactory rate of subjects to vacuum suction was up to 96 %, and clinical efficacy rate of the operation was 100 %. As to sliming cases, there were significant decreases in their measurements of figures or dimensions. In case of the lump from breast shaping by fat granule autograft, as well as the infection and induration caused by injection of polyacrylamide during breast anaplasty, vacuum suction could resolve all of them wonderfully. Conclusions When used properly, vacuum suction may play an excellent role in shaping sliming and breast anaplasty, and it can also resolve those complications brought up in breast shaping by fat granules autograftor and by polyacrylamide injection. Vacuum suction decreases the pain and cicatrisation caused by invasion surgery significantly.

ObjectiveTo evaluate the role of laparoscopic ultrasonography (LUS) in laparoscopic ureterolithotomy.MethodsLUS was utilized in laparoscopic ureterolithotomy for 7 cases of ureterolith to locate the ureter and stone.ResultsLUS demonstrated the relationship of the ureter to the adjacent structures and guided the dissection of the ureter in all the 7 patients and precisely localized the position of calculi.The stone could be touched by atraumatic clamps in 5 cases.LUS-demonstrated localizations of the ureter and calculi were verified on laparoscopic ureterotomy in the other 2.The mean operating time for LUS was 14 min (ranging from 9 to 20 min ).ConclusionsLUS is a real adjuvant means for locating the ureter and stone.

Objective:To investigate the clinical symptoms,personality features and treatment effect of stutterers of different ages.Methods:The SAS,SDS,MMPI and EPQ were administered to 159 stutterers and 110 normal controls.Result:The scores of SAS,SDS,EPQ and MMPI in stutterers were significantly different from that of normal controls.Conclusion:Clinical symptoms and personality of stutterers were different.

Objective To investigate the effect of carbon monoxide (CO) inhalation on acute hypoxic pulmonary arterial hypertension and acute hypoxic lung injury. Methods Thirty Wistar rats weighing 180-250 g were anesthetized with intramuscular 3% pentobarbital 50 mg?kg-1 . Pulmonary catheter was inserted via right external jugular vein for mean pulmonary arterial pressure (MPAP) monitoring. Left common carotid artery was cannulated for BP monitoring. Tracheotomy was performed and the animals were mechanically ventilated ( RR = 80-90 bpm). PETCO2 was maintained at 35-45 mm Hg. The animals were randomly divided into 3 groups: (1) control group inhaled 21 % O2 for 30 min ( n = 10); (2) hypoxia group inhaled 10% O2 + 90% N2 for 30 min ( n = 10) and (3) CO group inhaled 100 ppm CO in 10% O2 + 90% N2 for 30 min ( n = 10) . Arterial blood 4 ml was obtained at the end of experiment for estimation of blood HbCO and plasma MDA concentration and RBC SOD activity. A piece of lung tissue was obtained immediately after the animal was sacrificed for electron microscopic examination. Results (1) In hypoxia group MPAP was markedly increased, plasma MDA level elevated and SOD activity reduced as compared with control group ( P

Objective To evaluate systematically the effect of ventilator circuit changes on incidence of ventilator-associated pneumonia(VAP).Methods Literatures about the effect of ventilator circuit changes on occurrence of VAP were searched from PubMed,Cochrane Library,CNKI,VIP,and Wanfang database,incidence of VAP in pa-tients who received circuit changes at different intervals was compared,odds ratio (OR)and 95%CI were as effect index of the study,RevMan 5.2 software was used for data analysis.Results A total of 12 literatures were included,including 18003 patients using ventilators.According to the interval of ventilator circuit changes,patients were divided into 1-day group (n=191),2-day group(n=8932),3-day group(n=228),and 7-day group(n=8652).Meta analysis showed that circuit changed every 7 days had a lower risk of VAP than that changed once ev-ery day (OR,3.72[95%CI,1.50,9.23]),there was no significant difference in risk of VAP between 7-day group and 2-day group (OR,1.17[95%CI,1.00,1.37])as well as 7-day group and 3-day group(OR,0.77 [95%CI, 0.49,1 .23]).Conclusion Patients who received circuit changes every 7 days have a lower risk of developing VAP than those who received circuit changes once per day,so change the ventilator circuit in patients with mechanical ventilation every 7 days is more reasonable.