Objective To investigate the outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCABG) under morphine-fentanyl combined anesthesia. MethodsSeventy-two patients aged 41-64 yr undergoing OPCABG were randomly divided into 2 groups (n = 36 each): Ⅰ group morphine + fentanyl (group MF) and Ⅱ group fentanyl (group F). Anesthesia was induced with midazolam, etomidate, and vecuronium.Fentanyl 10-20 μg/kg was given iv when needed. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintsined with inhalation of 0.5%-2.0% isoflurane and intermittent iv boluses of vecuronium in both groups. Morphine 0.15 mg·kg-1·h-1 + fentanyl 8 μg·kg-1·h-1 were infused during operation in group MF, while in group F fentanyl 10 μg·kg-1·h-1 was infused. Morphine 0.75 mg/h was infused in group MF or fentanyl 10 μg/h in group F for postoperative analgesia after extubation. Recovery from anesthesia was assessed using a nine point (QoR) questionnaire. Pain was measured with VAS score and sedation with Ramsay sedation score ( 1 = fully awake, 6 = asleep, no response to verbal stimulus). The postoperative complications were recorded. ResultsQoR scores were significantly higher in group MF and in group F. The incidence of postoperative febrile reaction was significantly reduced in group MF. There was no significant difference in Ramsay sedation score and other postoperative complications between the 2 groups. ConclusionMorphine-fentanyl combined anesthesia is more beneficial for the prognosis in patients undergoing OPCABG compared with fentanyl combined anesthesia.

Objective To develop new methods to cultivate, retrieve and purify mouse mesenchymal stem cells (mMSCs). Methods Bone marrow was collected from 2-month-old Kunming mice by flushing femurs and tibias with complete medium of DMEM-LG. Cells were plated in a Petri dish. After 24 hours, non-adherent cells were removed by two to three washes with PBS, adherent cells were further cultured in complete medium and retrieved by trypsinisation with 0.25% trypsin for 5 min at 37 ℃. The treated adherent cells were cultivated with 3?dilution for further generations. CD11b-negative cells were retrieved from the collected adherent cells of 3rd generation by using immunomagnetic microbeads, and continued to be cultured in complete medium. After the cultured cells were retrieved, their morphology and their ability of osteoblastic differentiation and adipocytic differentiation were examined. Results Most of mMSCs from 1st generation were of shuttle shape, some of irregular shape. After treatment with magnetic microbeads and several generations, mMSCs were of spindle, star and irregular shape. These cells were of rich cytoplasma, clear nucleolus, and grew in parallel or vortex. The cultured adherent cells from the first and subsequent generations had plenty of CD11b-positive blooding-making cells. After 20-day osteoblastic induction, mMSCs differentiated into bone cells, which showed orange phosphate in extracellular matrix by Alizarin red S staining. mMSCs could differentiate into lipocytes. The size of cells increased along with fat-developing induction period. These cells showed many orange fatty follicles with O Red Oil dyeing. Conclusion Pure mMSCs can not be retrieved by either adhering method or generation cultivation method separately. The combined methods of adhering, immunomagnetic microbeads, and serial subcultivation is effective in vitro in retrieve mMSCs.

Objective To study the clinical application value of humidified high flow nasal cannula(HHFNC) on bronchitis in children.Methods Total 85 cases of bronchitis that needed oxygen therapy in our department from Oct 2015 to Feb 2016 were randomly divided into three groups,HHFNC group,NCPAP group and nasal cannula oxygen group(control group).According to the blood gas results,FiO2 was adjusted to maintain PaO2 in 50~70mmHg(1mmHg=0.133kPa),TcSO2 90% to 95%.The main symptoms and signs(wheezing,shortness of breath,three depression sign,wheezing rale) disappeared time,length of oxygen inhalation and stay,the change of PaO2,PaCO2,respiratory rate were compared among the three groups.Results Compared with control group,the clinical symptoms and signs disappeared time and length of oxygen inhalation and stay were significantly shorter in HHFNC group(P<0.05).The recovery of blood gas and respiratory rate in HHFNC group were better than those in control group(P<0.05).No statistically significant differences existed between HHFNC group and NCPAP group(P>0.05).Conclusion HHFNC can significantly improve the clinical symptoms,signs and blood gas results in children with bronchitis,reduce the length of oxygen inhalation and stay.HHFNC is an effective and well-tolerated treatment for bronchitis in children.

ObjectiveTo investigate the influence of different depths and mediums on tissue stiffness measurement by virtual touch tissue quantification technology.Methods Four kinds of in vitro porcine tissue were recruited,three (fat,muscle and liver) were assigned as medium group and three (kidney,liver and muscle) as sample group.The shear wave velocity (Vs) of the samples was measured under different mediums and at different depths (2 cm,3 cm,4 cm and 5 cm),respectively.ResultsAccording to the depth of measurement,two groups of Vs were defined with one group at the depth of 2 cm and 3 cm while the other at 4 cm and 5 cm.The difference of Vs between the two groups was of statistical significance and with the increase of the depth Vs values decreased.Even at the same depth,the differences of Vs under different mediums were statistically significant.ConclusionsDepths and mediums have great influence on evaluating elasticity measurements by virtual touch tissue quantification technology.

Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in diagnosis of renal epithelioid angiomyolipoma (eAML).Methods The CEUS features of 18 patients with 18 histopathologically proved renal eAMLs were retrospective analyzed using both of qualitative and quantitative approachs.Tumor conventional ultrasound and CEUS features were observed.The Sonoliver software was applied to perform quantitative analysis,which provided five parameters,including the maximum intensity (IMAX),rise time (RT),time to peak (TTP),mean transit time (mTT) and area under the curve (AUC).Results All of 18 lesions were pathological proved as eAML,among them,heterocyst was observed in 7 lesions,1 lesion had dissemination inter-kidney and vessel invasion,necrosis or cystic degeneration was found in 3 eAMLs.On conventional ultrasound,eAML showed hypoecho,isoecho and hyperecho were 14(77.8％),3(16.7％) and 1 (5.6％) respectively.Blood flow could be detected in 16 (88.9％) lesions.On CEUS,the characters of slow-in,synchronous-in,slow centripetal enhancement and entire enhancement were observed in 10 (55.6％),8 (44.4％),8 (44.4％) and 12 (55.6％) lesions,respectively.Most of eAMLs showed homogeneous enhancement (15/18,83.3％) and hyper-or iso-enhancement (16/18,88.8 ％) at peak time.The characters of fast-out,synchronous-out and slow out were observed in 8 (44.4％),2 (11.2％) and 8 (44.4％) cases,respectively.Pseudocapsule was detected in 5 (27.8％) lesions.The parameters of RT,TP and AUC for eAMLs were higher than that for renal cortex (P ＜ 0.05),while the parameters of IMAX and mTT had no significant statistical difference between eAMLs and renal cortex(P ＞0.05).Conclusions Qualitative and quantitative analysis of CEUS reflect the blood perfusion of eAMLs in different aspect,which offer some useful informations for the diagnosis of eAMLs.

Objective : To learn the preference and determinants for institute-based care of the elderly in Zhejiang Province. Methods : By multi-stage sampling and convenient sampling methods,three communities and three villages from Hangzhou,Jinhua and Yongkang as investigation spots,respondents who aged 60 years or above and lived for one year or more were selected for a questionnaire survey to learn their preference for institute-based care. Logistic regression analysis was used to explore the influencing factors for preference of institute-based care among the elderly. Results : A total of 390 valid questionnaires were collected,accounting for 91.76%. Among them,there were 219 men and 171 women, accounting for 56.15% and 43.85; 155 old people chose institute-based care,accounting for 39.74%. The results of multivariate logistic regression analysis illustrated that the elderly who had three children or more had less preference for institute-based care（OR=0.072,95%CI：0.007-0.742）;the elderly who lived with spouse（OR=0.395,95%CI：0.188-0.833）,with children（OR=0.323,95%CI：0.132-0.791）,with spouse and children（OR=0.305,95%CI：0.139-0.673）,compared with the elderly who lived alone,had less preference for institute-based care;the elderly who lived in rural areas,compard with the elderly who lived in urban areas had less preference for institute-based care（OR=0.404,95%CI：0.224-0.730）;the elderly without chronic diseases had less preference for institute-based care（OR=0.485,95%CI：0.292-0.805）. Conclusion Having three or more children,living with spouse,living with children,living with spouse and children,living in rural areas and living without chronic diseases are determinants for choosing institute-based care among the elderly.

Objective To analyze the urine trace albumin(mALb)/creatinine(Cr) ratio and blood uric acid(UA),and other various metabolic index level in patients with diabetic nephropathy(DN),combined with clinical data such as patients' age,body mass index(BMI),course of diseases,to explore the related mechanism of occurrence and development of DN.Methods 76 DN patients were selected.The microalbuminuria group(urinary mALb/Cr<300μg/mg) had 46 cases,the clinical albuminuria group(urinary mALb/Cr≥300μg/mg) included 30 cases,another 49 diabetic patients without kidney damage were seleted as control group.The urinary mALb/Cr,blood UA,fasting blood glucose(FBG),triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein(HDL),low density lipoprotein(LDL),glycosylated hemoglobin(HbA1c) levels were determined.The BMI and the length of the course of the disease calculate.Results The patients' age,course of the disease,urinary mALb/Cr,blood UA,FBG,TC,TG,LDL,HbA1c and BMI level in the clinical albuminuria group and microalbuminuria group were significantly higher than those in the control group,the differences were statistically significant (F=6.18,12.48,141.43,12.48,8.49,4.98,6.18,3.89,3.17,3.89,all P<0.05).The high uric acid hematic disease rates of the clinical albuminuria group and microalbuminuria group were 26.09% and 26.09%,which were significantly higher than 10.20% of the control group,the differences were statistically significant(x2=4.074,24.833,all P<0.05).Urinary mALb/Cr was positively correlated with age,duration,BMI,UA,TG,TC,LDL,FBG,HbA1c(r=0.120,0.299,0.148,0.340,0.157,0.149,0.103,0.487,0.103).Multiple linear stepwise regression analysis suggested that duration,blood UA,FBG were independent risk factors of urinary mALb/Cr;TG,BMI,urinary mALb/Cr were independent risk factors for blood UA.Conclusion Urinary mALb/Cr and blood UA are the independent risk factors,high uric acid hematic disease may participate in the development process of DN,and diabetes duration,UA,BMI,TG,TC,LDL,FBG,HbA1C associated with increased urinary mALb/Cr excretory DN patients,the effective monitoring can improve the symptoms of DN and quality of life.

OBJECTIVETo establish the atherosclerosis models (AS) in rats and observe the change process of AS and Shenlian decoction's pharmacological effect.

METHODTwo hundreds and forty rats were randomly divided into blank control group, model group, positive medicine group, the high-dose, middle dose and low-dose Shenlian decoction groups. Vascular pathological changes were observed by the methods of HE stain. The levels of TC, TG, LDL-C, HDL-C, NO in serum were determined respectively by enzyme colorimetric, clear and nitrate reductase methods. ET, TXB2, 6-keto-PGF1 alpha, TNF-alpha, IL-6 and IL-8 levels in serum were detected by radioimminoassay.

RESULTCompared with the model group, vascular lesion of different doses of Shenlian decoction groups were significantly improved, the TG, NO, TXB2 levels in serum were significantly lower (P < 0.05), while high-dose Shenlian decoction can significantly reduce TNF-alpha, IL-6, IL-8 levels in serum (P < 0.05).

CONCLUSIONShenlian decoction can inhibit the formation and development of AS by regulating blood lipids, improving endothelial function and reducing inflammatory factors release.

Animals ; Atherosclerosis ; blood ; drug therapy ; pathology ; prevention & control ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Interleukin-6 ; blood ; Male ; Protective Agents ; administration & dosage ; Random Allocation ; Rats ; Rats, Wistar ; Tumor Necrosis Factor-alpha ; blood

Objective:To investigate the role of a continuously developed information traceability system in the management of foreign medical instrument packages in central sterile supply department (CSSD).Methods:A total of 350 foreign medical instrument packages processed by CSSD during May to June 2021 in Shenzhen Hospital, University of Chinese Academy of Sciences were included in the control group. These packages were managed with the original information traceability system. A total of 375 foreign medical instrument packages processed by CSSD during July to August 2021 in Shenzhen Hospital, University of Chinese Academy of Sciences were included in the observation group. These packages were managed with a continuously developed information traceability system. Step-by-step reminding and early warning control were performed according to the problems encountered in actual operation. Quality management indexes of foreign medical instrument packages and the incidence of adverse events were compared between the two groups.Results:The percentages of good cleaning and functional integrity of the foreign medical instrument packages, functional integrity of sterile barrier after sterilization, timely monitoring of biological culture results, standardized handover, postoperative cleaning and detoxification in the observation group were 96.0% (360/375), 98.7% (370/375), 99.5% (373/375), 98.9% (371/375), and 99.7% (374/375), which were significantly higher than those in the control group [84.2% (295/350), 92.6% (325/350), 91.4% (320/350), 89.1% (312/350), 84.9% (297/350), χ2 = 28.48, 15.40, 27.72, 31.80, 58.12, all P < 0.05]. The percentages of instrument breaking, instrument mixed or damaged, wet packages, information label error, oversized and overweighed packages in the observation group were 0.8% (3/375), 0.3% (1/375), 0.8% (3/375), 0.3% (1/375), and 0.5% (2/375), respectively, which were significantly lower than those in the control group [4.3% (15/350), 4.6% (16/350), 3.4% (12/350), 10.0% (35/350), 7.7% (27/350), χ2 = 9.08, 14.65, 6.17, 36.34, 24.31, all P < 0.05]. Conclusion:A continuously developed information traceability system is very important for management of medical instrument processed in CSSD. A developmental traceability system not only continuously improves quality control of foreign medical instrument and decreases the incidence of adverse events, but also increases the responsibility and enthusiasm of staff, thereby ensuring the safety for patients.