Objective To evaluate the accuracy of an expiratory resistance device assisting pulse pressure variation (PPV) in predicting volume responsiveness in the spontaneously breathing patients.Methods Forty spontaneously breathing patients of both sexes,aged 22-61 yr,weighing 51-73 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective operation,were enrolled.Before induction of anesthesia,mean arterial pressure (MAP),heart rate (HR),central venous pressure (CVP),cardiac index (CI) and pulse pressure variation (PPVB) were recorded after haemodynamics were stable.Then the expiratory resistance device was used,and MAP,HR,CVP,CI,and PPVA were recorded.The device was then removed.Volume expansion was carried out.6％ hydroxyethyl starch 130/0.4 6 ml/kg was infused over 10 min.MAP,HR,CVP,CI and PPVB were recorded within 3 min after volume expansion.The device was used again,and 1 min later MAP,HR,CVP,CI and PPVA were recorded.The device was then removed.The patients were divided into 2 groups according the percentage of increase in CI after volume expansion (△ CI):△ CI≥ 15％ considered to be a positive response group (group P),and ACI＜15％ considered to be a negative response group (group N).A receiver-operating characteristic (ROC) curve for PPV was plotted.According to the ROC curve,the diagnostic threshold,sensitivity,specificity,area under the curve,and 95％ confidence interval of the expiratory resistance device assisting PPV in predicting volume responsiveness were determined.Results The area under the curve (95％ confidence interval) of PPVA was 0.880 (0.70-0.98),the diagnostic threshold was 13.5％,and the sensitivity and specificity in determining volume responsiveness were 87％ and 88％,respectively.Compared with the value before administration of the loading dose,the CVP and CI were significantly increased,and PPVB and PPVA were decreased after volume expansion in group P,and the CVP and CI were significantly increased after volume expansion in group N (P＜0.05).Compared with group P,the PPVA was significantly decreased before volume expansion,and the CI was increased after volume expansion in group N (P＜0.05).Conclusion The expiratory resistance device can assist PPV in predicting volume responsiveness in the spontaneously breathing patients.

Objective To summarize the key point of application of acellular dermal matrix(ADM)in operative cooperation of pharyngeal tissue repair.Methods In order to rebuild the air-tight cavity,ADM was sewn to the anterior vertebrae fascia in 7 patients with pharyngeal malignant tumor undergoing total laryngectomy or pharyngolaryngectomy to rebuild the posterior wall of the laryngopharynx.Meanwhile the muscular flap of the pectoralis major Was used to rebuild the anterior and lateral walls of the laryngopharynx.Results There was no reject reaction or pharyngeal fistula in these 7 cases and the wound surface were all mucous membranized.All the incisions reached the primary healing.Conclusions ADM is easy to get and possesses good histocompatibility and compatible thickness.It is easy to be managed during operation and can modify the peripharyngeal defect with the combination of muscular flap of the pectoralis major or any other neck tissue.Strict nursing preparation before operation and perfect cooperation during operation are key steps to complete the surgery successfully.

Objectives To study the relationship between TCM syndromes and adiponectin (APN) level, carotid atherosclerosis plaque of hypertension complicated with carotid atherosclerosis, and provide evidence for clinical diagnosis and treatment. Methods One hundred patients of hypertension complicated with carotid atherosclerosis were divided into phlegm syndrome group, stasis syndrome group, and intermingled phlegm and blood stasis syndrome group, and compared with 30 healthy people as control. Carotid atherosclerosis plaque was detected with GE LOGIQ500 color ultrasound system. ELISA was used to determine the serum APN. Results APN of the intermingled phlegm and blood stasis syndrome group was obviously lower than other groups, and there were obvious differences among them. There were more plaques in the intermingled phlegm and blood stasis syndrome group. A negative correlationship was showed between carotid artery intima media thickness (IMT) and APN of hypertension complicated with carotid atherosclerosis. Conclusion There is correlation between TCM syndrome and APN level, carotid atherosclerosis plaque of hypertension complicated with carotid atherosclerosis. The anomalous change of APN and plaque formation of the patients can be preliminarily estimated with the syndrome of TCM.

Objective To optimize the matrix prescription and preparation technology of compound pyocutaneous gels. Methods Use the method of L9(34 ) orthogonal test, take the Carbopol-940 quantity, pH, glycerol and ethanol as factors,and take viscosity, pH value, appearance properties, temperature resistance as the comprehensive evaluation index, and compare the effects of stewing, centrifugal and ultrasound methods on removing bubbles in the gel. Ultimately determine the optimum preparation process. Results The best matrix prescription of compound pyocutaneous gels is as follows: carbopol-940 1.4%, 10% sodium hydroxide solution 3.3%,glycerol 2.3%,ethanol 6%;the best way to remove bubbles is centrifugation,with rotation rate at 3 000 r?min-1 for 10 min. Conclusion The selected matrix formulation is simple and feasible, the preparation technology is stable and reliable with good reproducibility, and can be used for the preparation of compound pyocutaneous gel.

Objective To explore the effects of nurses′ risk perceptions of occupational HIV exposure and the self-efficacy on their attitudes and behavior of self-protection in nursing care. Methods An anonymous survey was conducted in eligible nurses with self-designed questionnaire in three conveniently selected comprehensive hospitals in Wuhan. Structural equation modeling was applied in the data analysis. Results Risk perceptions exerted positive effects on the attitudes of self-protection. The standardized path coefficient was 0.45 (P=0.009). The attitudes of self-protection and the risk perceptions exerted no impact on the behavior of self-protection (P > 0.05).The impacts of the self-efficacy on the attitudes and the behavior of self-protection was positive. The standardized path coefficient was 0.15(P=0.02)and 0.53 (P<0.01), respectively. Conclusions Risk perceptions exerted positive effects on the attitudes of self-protection. But the attitudes of self-protection and the risk perceptions exerted no impact on the behavior of self-protection. Self-efficacy can improve the attitudes of self-protection and enhance the behavior of self-protection.

Objective To explore the clinical features of respiratory syncytial virus(RSV) pneumonia in full-term neonatal patients.Methods All 422 full-term newborns diagnosed as pneumonia in NICU of Shenzhen Children's Hospital during January 2014 to January 2015 were included in this study.They had been detected for RSV in the way of direct immunofluorescence assay.According to the detection results, they were divided into RSV positive group and RSV negative group, the clinical data in two groups were analyzed.Results Forty-five cases were RSV positive,377 cases were RSV negative.The proportion of breast feeding was 42.22％ vs.65.25％ ,the proportion of cesarean section was 20.00％ vs.76.12％ in two groups,there were significant differences between the two groups.Hospitalization time, birth weight, gestational age, the age of admission showed no difference between two groups.The incidencs of cough (100％), shormess of breath (88.89％), three depressions (48.89 ％), fine rales (66.67 ％), wheezing (22.22％) in RSV positive group were higher than those in the RSV negative group(84.88％ ,42.44％, 13.26％, 13.53％ ,3.98％ respectively), there were significant differences between the two groups.The incidences of fever, saliva, nasal showed no significant difference between the two groups.There was significant difference in the X-ray chest film performance between two groups,RSV positive group was more emhrysema(71.11％ vs.6.9％) ,and less patch shadow(88.89％ vs.93.10％).The laboratory examination of blood routine test, C-reactive protein,respiratory failure, the positive rate of sputum culture, pneumothorax, pleural effusion were without differences.Conclusion RSV is an important pathogen of full-term neonates with infectious pneumonia.Breastfeeding and eutocia can reduce the incidence of RSV infection.Cough, shortness of breath, pulmonary rales, and emphysema in X-ray were common in RSV pneumonia.

OBJECTIVETo evaluate the efficacy of endoscopic variceal sclerotherapy (EVS) for esophago gastric variceal bleeding.

METHODSA retrospective analysis was made on 1010 patients with esophagogastric variceal bleeding who underwent sclerotherapy, among whom there were 834 patients with cirrhosis, 160 with hepatocarcinoma, 12 with Budd-Chiari syndrome and 4 with congenital liver fibrosis. Totally, 3203 sessions of sclerotherapy were performed, including 602 sessions of emergency sclerotherapy and 2601 of selective surgery. The average number of sessions of sclerotherapy for the initial treatment in 710 cirrhosis patients who received continuous sclerotherapy was 3.2 +/- 1.1 times. Follow-up was done in 579 cirrhosis patients for 3-157 months, with an average period of 42.5+/- 32.8 months.

RESULTSThe rate of emergency hemostasis in the whole group was 97.0%. The rate of complications was 13.4%, and the mortality rate was 1.8%. The rate of complete eradication and basically complete eradication of esophagogastric varices in cirrhosis patients was 84.1%. The late rebleeding rate was 23.7%, and the survival rates were 95.8% +/- 0.8%, 86.1% +/- 1.6%, 74.5% +/- 2.4%, 53.6% +/- 3.8% at 1, 3, 5 and 10 years, respectively, according to Kaplan-Meier analysis.

CONCLUSIONEVS is an important method for the treatment of esophagogastric variceal bleeding.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Esophageal and Gastric Varices ; therapy ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sclerotherapy

Objective : To investigate the role of knockdown of peroxiredoxin-6 ( PRDX6) in injury and adaptive expression of bile acid transporter in human hepatoellular carcinomas ( HepG2 ) cells induced by rifampicin (RFP) . Methods : Cells in logarithmic growth phase were uniformly inoculated in six-well plates , and HepG2 cells were transiently transfected with specific PRDX6-siRNA and control-siRNA to construct the knockdown group and control group . After 24 h of induction with 100 μmol/L RFP , Western blot and qRT-PCR were performed to detect the protein and gene expression levels of PRDX6 , multidrug resistance protein 1 (MDR1) , multidrug resist- ance-associated proteins 2 , 3 and 4 (MRP2 , MRP3 and MRP4) , and Na + /taurine taurocholate cotransporter pro- tein (NTCP) . Annexin V-FITC/PI double staining assay was used to detect the apoptosis rate of cells in each group ; CCK-8 assay was used to detect the changes of cell proliferation in each group; The relative contents of ala- nine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBIL) , indirect bilirubin (IBIL) and total bile acid (TBA) in the supernatant of cell culture medium of each group were detected by kits . Results : RFP increased the protein and gene expression levels of MRP2 , MRP3 , MRP4 , MDR1 , NTCP and PRDX6 in HepG2 cells (P < 0. 05) , while the protein and gene expression levels of MRP2 , MRP3 , MRP4 , MDR1 and NTCP decreased to different degrees after PRDX6 knockdown (P < 0. 05) . In addition , PRDX6 knockdown re- sulted in increased apoptosis rate of HepG2 cells (P < 0. 05) , decreased cell proliferation ability (P < 0. 05) , and increased levels of cell injury markers (ALT , AST , TBIL , DBIL , TBA) in cell culture supernatants (P < 0. 05) . Conclusion RFP increased the protein and gene expression of bile acid transporter and PRDX6 to increase in HepG2 cells . However , following knockdown of PRDX6 and treatment with RFP , the protein and gene expression levels of the bile acid transporter decreased and cell injury was aggravated , suggesting that PRDX6 played a protec- tive role in RFP-induced adaptive response in HepG2 cells .

Objective : To investigate the effect of mesencephalic astrocyte-derived neurotrophic factor (MANF) on the adaptive expression of bile acid transporter in human hepatoellular carcinomas (HepG2) induced by rifampicin (RFP) ． Methods: The control group cell line (Y07) and the knockdown group cell line (Y25) were constructed by lentiviral stable transfection technology．The Y07 and Y25 cells were treated with RFP of 200 μmol / L for 48 h， and qRT-PCR and Western blot were used to detect the protein and gene expression levels of MANF，bile salt export pump ( BSEP) ，multidrug resistance-related proteins 2 /3 /4 ( MRP2 ，MRP3 ，MRP4) ，multidrug resistance protein 1 (MDR1) ，organic solute transporter a / β ( OSTα/ β) ，organic anion transporter ( OATP2B1) ．The protein and gene expression levels of proliferating cell nuclear antigen ( PCNA) ，proliferating cell marker Ki67 were used to evaluate the proliferation of cells in each group changes in levels．Changes in the protein and gene expression levels of C / EBP homologous protein( CHOP) and cysteinyl aspartate specific proteinase-3 ( Caspase-3) were used to evaluate the apoptosis of cells in each group．The relative contents of alanine aminotransferase(ALT) ，aspartate aminotransferase(AST) ，alkaline phosphatase ( ALP) ，total bilirubin ( TBIL) ，indirect bilirubin ( IBIL) and total bile acid(TBA) in the supernatant of cell culture medium of each group were detected by kits. Results: RFP could induce the protein and gene expression of MANF，BSEP ，MRP2 ，MRP3 ，MRP4 ，MDR1 ，OSTα , OSTβ , OATP2B1 in HepG2 cells (P ＜0. 05 ) ，while the protein and gene expression levels of BSEP ，MRP2 ，MRP3， MRP4，MDR1，OSTα、OSTβ、OATP2B1 decreased after MANF knockdown(P＜0. 05) ．Moreover，under the action of RFP，the protein expression of PCNA and Ki67 in the knockdown group was still higher．The protein and gene levels of CHOP and Caspase-3 significantly increased after MANF knockdown(P＜0. 05) ．The levels of the hepatic cell injury markers in the cell supernatant increased significantly(P＜0. 05) ． Conclusion RFP can induce the expression of bile acid transporter such as BSEP，MRP2，MRP3，MRP4，MDR1，OSTα , OSTβ and OATP2B1 to increase in HepG2 cells(P＜0. 05) ，but the expression of bile acid transporter of HepG2 after MANF knockdown will significantly decrease under the induction of rifampicin(P＜0. 05) ，and cell indury is aggravated，indicating that MANF plays a protective role in RFP-induced adaptive responses by regulating the bile acid transporter.

Objective: To compare the efficacies of the two techniques of "micro-hemostasis and micro-cutting" with straight bipolar electrocoagulation forceps and traditional clamp-ligation for hemostasia in thyroid surgery. Methods: A total of 228 patients who underwent surgical treatment for thyroid neoplasms in our hospital between January 2015 and December 2018 were retrospectively analyzed, including 50 males and 178 females, aged 23-68 years old. Of those, 150 cases as electric knife group received traditional thyroid surgery between January 2015 and December 2018 and 78 cases as bipolar electrocoagulation group received thyroid surgery by using the technique of bipolar electrocoagulation with meticulous anatomy between January 2018 and December 2018. The total operation time, single operation time, intraoperative hemorrhage, postoperative drainage volume on the first day, postoperative hoarseness and hypocalcemia were compared between the two groups. SPSS 16.0 was used to analyze the data. Results: The total operation time and intraoperative hemorrhage in the bipolar electrocoagulation group were significantly lower than those in the electric knife group ((59.33±18.29)min vs (77.21±25.39)min, (14.83±9.22)ml vs (36.86±11.80)ml, all P<0.01). The single operation time of the bipolar electrocoagulation group was shorter than that of the electric knife group((10.25±6.16) min vs (20.34±7.24)min, (16.25±7.15)min vs (35.68±8.25)min, (12.12±5.25)min vs (20.68±7.26)min, t value was 3.948,16.262,8.238, all P<0.01).There was no significant difference between the two groups in postoperative drainage volume on the first day (P>0.05) and the incidence of postoperative hoarseness (P>0.05), while the incidence of hypocalcemia in the bipolar electrocoagulation group(10.26%) was lower than that in the electric knife group(21.33%,χ²=4.353, P<0.05). Conclusions The fine dissection for thyroid operation can be achieved by using straight bipolar electrocoagulation tweezers. The use of "micro-hemostasis" and "micro-cutting" technique with bipolar electrocoagulation tweezers can greatly reduce intraoperative bleeding, operation time and postoperative complication.