Objective To study the application of total intravenous anesthesia(TIVA) in patients with larp-aroscopic cholecystectomy(LC). Methods 100 cases with LC were randomly and evenly assigned to two groups: the combined intravenous with inhalation anesthesia(CIIA) group(n = 50) and the TIVA group(n = 50). The maintain anesthesia. BP, HR and SpO2 at all stages and time for extubation,the consciousness were recorded. Results The pneumoperitoneum after 10 min HR(96.8±13.5)times/min,SBP(142.5±14.3) mmHg、DBP(93.0±14.3) mm-Hg in A group higher than before induction of anesthesia(82.3±12.5) times/min, (129.0±21.7) mmHg, (77.3±13.5) mmHg(P < 0.05～0.01) ; The pneumoperitoneum after 10 min HR (84.0±11.0) times/min, pneumoperito-neum comphte(76.3±9.0) times/rain in B group lower than the(96.8±13.5) times/min, (84.1±11.0) times/min in A group(P >0.05); B group patients completed the opening time(6.5±1.5) min、extubation time (11.5±1.4) min、pestoperative nausea and vomiting in 3 cases,after 8 h VAS value of (2.8±1.1) in group B were lower than the (10.5±2.8) min,(25.2±9.5)min,12 cases(5.4±2.1) in group A(t =2. 411, P <0.05). Conclusion The application of TIVA to LC anesthetic effect is satisfaction.

Objective To observe the analgesic effect after cesarean section with different paregoric meth-ods. Methods 100 cesarean patients were randomly divided into A and B group. A group adopted patient controlled epidura analgesia(PCEA) micro-injection pump;B group using patient controlled intravenous analgesia(PCIA) mi-cro-injection pump,patients were observed and recorded for their pain, vomit disgustingly, exsufflation and the time of first urination or accidentally tube pull-out. Results The time of average surgery for A, B group were (53.5±8.5) min, (54.7±8.2) min, between the two groups was not significant (t=1.524, P>0.05) ; A group of visual Analog score (1.49±0.43) points were significantly higher than B group (1.13±0.56) points(t=2.119,P<0.05) ;the incidence of headache, dizziness, nausea and vomiting, skin itching(30.0%, 16.0% ,6.0%) in A group were signifi-candy higher than B group(16.0%,8.0% ,2.0%) (t=2.223, t=2.313, t=2.283, all P>0.05) ; the time of A first exhaust,voiding time[(24.56±8.77) h, (6.51±1.57) h] in A group were significantly higher than B group [(19.29±8.16)h,(4.06±1.76)h](t=2.445,t=2.415,P<0.05). Conclusion PCIA method was safe,effec-tive and allowed patients to have early activities after treatment and to promote early rehabilitation. It should be promo-ted for cesarean section.

Objective To investigate the effects of Celecoxib,a selective COX-2 inhibitor,on the healing of gastric ulcer in rats,and reveal the rale of ERK signal transduction pathway in the mechanism of delaying the healing of gastric ulcer.Methods Forty-eight rats were randomly divided into model group(n=40) and sham operation group(n=8).In the rats in model group acetic acid-induced gastric ulcer was reproduced,while in sham operation group,rats underwent the sham procedure.Eight rats in sham-operation group and eight rats in model group were euthanized three days after the procedure.The other thirty-two rats in model group were divided into two subgroups including Celecoxib group and NS group(n=16).Three days after the procedure,rats in Celecoxib group received a gavage of 0.2% Celecoxib solution,and those in NS group received equal amount of 0.9% NaCl solution.Rats in Celecoxib group and NS group were euthanized on sixth and ninth day after ulcer induction(8 rats at each time point in each group).The effects of Celecoxib on the healing of gastric ulcer were observed.Its effects on the activity of Raf-1 and ERK1/2,and the expression level of two transcription factors c-Fos and c-Jun were also determined by Western blot analysis.Results Nine days after ulcer induction,the ulcer area was 11.9?3.1mm2 and 19.7?3.8mm2 in NS group and Celecoxib group,respectively,and they were much smaller than those on third day(P

Objective To explore the expressions of stromal cell derived factor 1 α (SDF-1α) and cysteine-X-cysteine chemokine receptor 4 (CXCR4) in the peripheral blood of patients with systemic lupus erythematosus (SLE).Methods Forty hospitalized SLE patients were recruited and twenty healthy volunteers were enrolled as normal controls.The percentage of CD3+CD4+CXCR4+,CD3+CD8+CXCR4+ and the plasma concentration level of SDF-1α in the control group and SLE patients were detected by flow cytometry and ELISA.The relationship between SDF-1α/CXCR4 and SLEDAI was explored.Kruskal-Wallis H,Pearson's and Mann-Whitney U test were used for statistical analysis.Results the expression of SDF-1α [329 (127,539) pg/ml] and CXCR4 [CD3+CD4+CXCR4+:4.20(2.01,6.35)％,CD3+CD4+CXCR4+:2.70(1.68,4.20)％] were significantly elevated in SLE patients when compared to the normal controls (Z=-6.277,-5.707,-4.885,respectively,all P=0.000),and were significantly increased in highly active SLE patients than less active SLE (Z=-5.414,-5.256,-5.312,P＜0.01).The expression of SDF-1α and CXCR4 in the butterfly erythema group,anemia group and proteinuria group were significantly higher than the normal group (P＜0.05).Both SDF-1αand CXCR4 were positively correlated with SLEDAI (r=0.857,0.830,0.861,respectively,all P＜0.01).Conclusion The expressions of SDF-1α and CXCR4 increase significantly in the peripheral blood of SLE patients and there is close relationship between SDF-1α/CXCR4 and disease activity,organ damage.The results of this study suggestthat SDF-1α/CXCR4 may play an important role in the pathogenesis of SLE.

A 36-year-old female presented with multiple dark brown papules on the chest and abdomen for more than 10 years,which had gradually increased in number.Physical examination revealed dozens of dark brown,flat papules measuring 1-3 mm in diameter in the chest and abdomen.Most of the lesions had a smooth surface,and some lesions gave a papilloma-like appearance,with no confluent trend.Biopsy of abdominal lesions showed mild hyperkeratosis of epidermis,acanthosis,extension of epidermal protrusions forming a reticulated appearance,horn pseudocysts in prickle cell layer,enhanced pigmentation of basal layer,and a sparse lymphocytic perivascular infiltrate in superficial dermis.A diagnosis of dermatosis papulosa nigra (DPN) was made.

OBJECTIVE To explore the incidence of sharp instrument injuries among nurses from the various classes of medical institutions and to analyze the cause and investigate the preventive countermeasures.METHODS To survey the sharp instrument injuries in nursing among 1050 nurses from 50 medical institutions.From 1050 questionaires,1028 were performed.RESULTS Among 1028 nurses from 50 medical institutions,903 nurses suffered different degrees of sharp instrument injuries with 87.84%,of which 40.75% and 31.12% were caused respectively in working age of 6-10 years and 11-15 years.All injury cases added up to 7059,with average of 7.80 times per person and 287(31.78%) cases were with over 10 times.Injuries for ampule in dispensing and clearance of instruments accounted for 70.63% and 15.54%,with the times of 4986 and 1097.Degrees of injury:the light injury of skin accounted for 57.69% with 4076 cases.CONCLUSIONS It is suggested to reform the craft of ampules and safety of instruments continually.Instrument cleaner is recommended if necessary.The key point is to strengthen the education of awareness on occupational protection and do self-protection best,which is sharply important to reduce the incidence of injuries.

Objective To provide references for reasonable procurement planning, TCM decoction pieces reserving and clinical medication guarantee by analyzing the usage of TCM decoction pieces and granules from 2011 to 2014 in Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine (hereinafter referred to as Zhuhai Hospital). Methods The sale data of TCM decoction pieces and granules during 2011-2014 in the database of Zhuhai Hospital were analyzed. Sales quantity, sales amount of the category and single pieces of TCM decoction pieces and granules ranking the first 10 were analyzed. Results The sales quantity and amount of TCM decoction pieces and granules were increasing from 2011 to 2014. The usage weight ratio and usage amount ratio between TCM decoction pieces and granules was stable. The top 10 categories and single pieces in sales quantity and amount were also stable. Conclusion Zhuhai Hospital has its own characteristics in TCM types, categories and dosage forms. TCM decoction pieces play an important part in clinical treatment in Zhuhai Hospital.

Objective To identify the correlation between vitamin D prescription and recurrence in rheumatoid arthritis (RA).Methods A randomized controlled trial study was performed in 170 RA patients who were in remission during the past 2 months.According to the level of vitamin D,170 RA patients were divided into normal vitamin D group (84 patients) and deficiency vitamin D group (86 patients).Deficiency vitamin D group were randomly allocated to receive vitamin D treatment(vitamin D treatment group) or without vitamin D treatment (control group).In the 6-month follow-up period,the recurrence status was observed and compared.Results In the 6-month follow-up period,the recurrence rate of RA in normal vitamin D group was 16.7％(14/84),in vitamin D treatment group was 19.0％(8/42) and in control group was 29.5％(13/44),and there was no significant difference (P ＞ 0.05).In vitamin D treatment group,no hypercalcemia and hyperphosphatemia occured.The age,course of disease and remission time in recurrence patients of three groups were no significant difference (P ＞ 0.05).The level of vitamin D in recurrence patients of vitamin D treatment group was higher than that in recurrence patients of control group:(25.5 ± 8.9) ng/L vs.(20.9 ± 8.6)ng/L,and there was significant difference(P＜ 0.05).Conclusion Vitamin D deficiency is not identified to be a risk factor for RA recurrence.Vitamin D does not reduce the recurrence of RA.

Objective To investigate the characteristics of dysplasia in myeledysplastic syndrome (MDS). Methods 716 samples of adult patients with abnormal blood routine and unelear cause were collected between July 04, 2003 and March 14, 2007. Based on the gold diagnostic standard of WHO MDS classification, all eases were detected on cytomorphology, cytochemical stain, bone marrow pathological assay,cytogenetics, flow eytometry et al. The cytological study of bone marrow on some abnormal hematopaietie cells has a diagnostic value to determine clonal or non-clonal diseases and assess sensitivity and specificity. Results in the complicated various dysplasia of hematopeiefic ceils, the following characteristics can be the main basis of cytomorphological diagnosis: one of granular Auer bodies, micronuclens (MN), or nuclear budding, erythroid nuclear budding, megakaryocytes presented in peripheral blood, myeloblast or prorubricyte exhibited in peripheral blood, ringed sideroblasts>1%. The subordinate basis of cytomorphological diagnosis development of nuclei, ring-shaped nuclei, and aggregation of nuclear chromafin, erythroid multi-nuclei, odd nucleus, mother-daughter nucleus, nuclear fragmentation, vacuole, anisoeytosis and mieromegakaryocytes.Conclusion Cytomorphologic assay is the base for the diagnosis of MDS, however, it presents certain limit,especially when eytomnrphoiogical change does not possess specificity for early MDS. Hereby, it requires to combine other deteetion methods.

ObjectiveTo explore the clinical presentation, diagnosis, treatment, and outcome of the Barth syndrome (BTHS).MethodsClinical data were collected and analyzed from 3 patients with conifrmed genetic diagnosis of BTHS from June 2013 to October 2014.ResultsAll of the 3 patients were males and two of them were twins. The main clinical manifes-tations of the 3 patients were cardiomyopathy and heart failure, accompanied by different degrees of trabeculations of the left ventricle. Two of them were diagnosed of left ventricular noncompaction (LVNC). All of the 3 patients presented with motor retardation, muscle weakness, growth delay and signiifcantly increased urinary excretion of 3-methylglutaconic acid (3-MGC). One patient was found to have neutropenia. All 3 patients hadTAZ gene mutations which included a novel missense mutation (c.527A>G, p.H176R) detected in the twins and a known nonsense mutation (c.367C>T, p.R123X) identiifed in the other patient. All of the mutations were inherited from their mothers. During the follow-up, the twins died at 7 months old and 7.5 months old respectively. The other patient was still alive.ConclusionBTHS is one of the causes of cardiomyopathy in children. In the male patients who presented with muscle weakness, neutropenia, and increased urinary excretion of 3-MGC, especially in those com-bined with LVNC, BTHS should be screened.