Objective To study the smoking status and revalent cause factors among medical college students in Nanchang and provide information for smoking control .Methods A questionnaire survey was conducted among 935 medical students by stratified cluster random sampling method .912 questionnaires were valid .The valid rate was 97 .540% .Results The total smoking rate was 14 .364% (131/192) .The smoking rate of male was higher than female(χ2 =49 .982 ,P<0 .05) .There was a great difference among different grades(χ2 =22 .503 ,P<0 .05) .There were many factors associated with smoking conducts ,in which older ,higher family income ,higher monthly cost of living ,allowing to smoking in the home were risk factors ,but mother′s educational level ,correct knowledge about the hazards of tobacco were protective factors .Conclusion The smoking rate of medical students is not high .The smoking status are influenced by many factors .Intervention should pay more attention to focus group and better prevent medical students from smoking .

Objective To investigate the effect of dexmedetomidine on activations of pulmonary extracellular signal-regulated kinase 1/2 (ERK 1/2 )and serine-threonine kinase (Akt) during isolated lung ischemia-reperfusion injury (LIRI)in rats.Methods Forty-five adult male Spra-gue-Dawley rats were randomly divided into three groups (n=1 5 each):control group (group C),is-chemia-reperfusion group (group IR)and dexmedetomidine group (group DEX).Isolated rat lungs were maintained for normal physical activity,and only received ventilation and perfusion for 150 min in the IL-2 ex-vivo lung perfusion system in group C.Isolated rat lungs were subjected to 60 min of is-chemia and apnea followed by 75 min reperfusion and ventilation 15 min after perfusion in the IL-2 ex-vivo lung perfusion system in groups IR and DEX.Dexmedetomidine with a dose of 10 nmol/L was ad-ministrated into perfusion fluid at the onset of reperfusion in group DEX,and the same volume of saline was injected when perfusion for 75 min and at the onset of reperfusion in groups C and IR,respectively.Patho-logical changes of lungs were examined and the injured alveolus rate (IAR)was counted under light micro-scope.The expression levels of ERK 1/2 or Akt mRNA and phosphorylate-ERK 1/2 (p-ERK 1/2 )or phosphorylate-Akt (p-Akt)protein of lung tissue were tested by reverse transcription-polymerase chain re-action (RT-PCR)and Western blot,respectively.Results Compared with group C,the IAR and the ex-pression levels of ERK 1/2 and Akt mRNA or p-ERK 1/2 and p-Akt protein in lung tissue were high-er in groups IR and DEX (P<0.05).Compared with group IR,the IAR and the expression levels of ERK 1/2 and Akt mRNA or p-ERK 1/2 and p-Akt protein in lung tissue were lower in group DEX (P<0.05).Conclusion Dexmedetomidine may reduce LIRI in rat isolated lungs via inhibiting the expressions of IL-6 and IL-8,and the mechanism may be related to suppressing activations of ERK 1/2 and Akt.

Objective:To evaluate the optimization strategy of labor analgesia in obese parturients using dural puncture epidural (DPE) combined with programmed intermittent epidural bolus (PIEB).Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ obese primiparae, who were at full term with a singleton fetus in vertex presentation, aged 20-40 yr, with body mass index of 30-40 kg/m 2, at 37-42 week gestation, with cervical dilation of 2-5 cm, and with visual analogue scale score ≥50 mm, were divided into 2 groups ( n=40 each) using a random number table method: DPE plus PIEB group (DPEP group) and DPE plus continuous epidural infusion group (DPEC group). All parturients received DPE labor analgesia, and parturients received PIEB (DPEP group) and continuous epidural infusion (DPEC group) to maintain analgesia during labor. In DPEP group, the patient-controlled epidural analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval and background infusion at 2 ml/12 min after an initial dose of 8 ml. In DPEC group, the patient-controlled epidural analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval and background infusion at 10 ml/h after an initial dose of 8 ml. The analgesia solution contained 0.1% ropivacaine plus 0.3 μg/ml sufentanil. The time to achieve adequate analgesia, consumption of ropivacaine per unit time, height of sensory block at the thoracic vertebral level, modified Bromage score, effective pressing times of patient-controlled analgesia, the number of rescue analgesia, Apgar score, delivery mode, occurrence of adverse reactions and maternal satisfaction with labor analgesia were recorded. Results:Compared with DPEC group, the time to achieve adequate analgesia was significantly shortened, the consumption of ropivacaine per unit time was decreased, and the number of rescue analgesia and effective pressing times of patient-controlled analgesia were decreased in DPEP group ( P<0.05). There were no significant differences in the height of sensory block at the thoracic vertebral level, modified Bromage score, Apgar score, delivery mode, incidence of adverse reactions and maternal satisfaction with labor analgesia between the two groups ( P>0.05). Conclusions:DPE combined with PIEB offers faster onset and better effect and achieves a greater local anesthetics-sparing effect when used for labor analgesia in obese parturients.

Objective To evaluate the effect of ulinastatin on programmed necrosis in hippocampal neurons in a rat model of global cerebral ischemia-reperfusion (I/R).Methods Forty-eight clean-grade healthy adult male Sprague-Dawley rats,aged 8 weeks,weighing 280-320 g,were divided into 3 groups (n=16 each) using a random number table method:sham operation group (Sham group),global cerebral I/R group (I/R group) and ulinastatin group (UT group).Global cerebral I/R was produced by 4-vessel occlusion method in chloral hydrate-anesthetized rats in I/R and UT groups.Ulinastatin 100 000 U/kg was injected via the tail vein at the onset of ischemia in group UT,and the equal volume of normal saline was given instead in Sham and I/R groups.Neurological deficit score (NDS) was estimated at 6,12 and 24 h of reperfusion.Animals were sacrificed at 24 h of reperfusion,brains were removed and the hippocampi were obtained for examination of pathological changes (with a light microscope) and for determination of the malondialdehyde (MDA) content and superoxide dismutase (SOD) activity (by spectrophotometry),and expression of receptor-interacting protein kinase 1 (RIPK1),RIPK3,and mixed lineage kinase domain-like protein (MLKL) in hippocampal tissues (by Western blot).Results Compared with Sham group,the NDS was significantly increased at each time point,the MDA content was increased,the SOD activity was decreased,and the expression of RIPK1,RIPK3 and MLKL was up-regulated in I/R and UT groups (P＜ 0.05).Compared with I/R group,the NDS was significantly decreased at each time point,the MDA content was decreased,the SOD activity was increased,and the expression of RIPK1,RIPK3 and MLKL was down-regulated in UT group (P＜0.05).The pathological changes of hippocampi were significantly attenuated in UT group when compared with I/R group.Conclusion The mechanism by which ulinastatin ameliorates global cerebral I/R injury is related to inhibiting programmed necrosis in hippocampal neurons of rats.

Primary multiple pulmonary nodules have a high incidence,and the size and number of pulmonary nodules on computed tomography images increase with time.Postoperative pathology of multiple pulmonary nodules shows chronic inflammation,adenomatoid change,carcinoma in situ,microinvasive carcinoma,infiltrating carcinoma,and other forms.There is a possibility of"inflammation-cancer transformation"in multiple pulmonary nodules with prolonged time and external irritation.The accumulation of dampness phlegm and blood stasis is the basis of the theory of"inflammation-cancer transformation."Healthy qi deficiency is the key to the"inflammation-cancer transformation."Qi and yang deficiency are the root cause of healthy qi depletion.Emotional depression,dampness,phlegm,and blood stasis transforming into toxins provide the impetus for"inflammation-cancer transformation."There are struggle between healthy qi and evil qi,and waxing and waning of dampness,phlegm and blood stasis in the process of"inflammation-cancer transformation."The dampness phlegm and blood stasis will increase when evil qi increases and healthy qi decreases.In contrast,the size,number,and malignancy of nodules will increase during healthy qi deficiency,showing a dynamic shift from inflammation to atypical adenomatous hyperplasia to cancer.The dampness phlegm and blood stasis will be absorbed as the healthy qi increases and evil qi decreases so that lung cancer can be reversed.External irritation,such as acute inflammatory stimulation,may accelerate the transformation of"inflammation-cancer"in multiple pulmonary nodules.

Multiple myeloma(MM)is a malignant plasmacyte disease that often presents with symptoms such as bone pain and anemia.Currently,there is an increasing number of literature re-ports on malignant tumors combined with hyperamylasemia,but this is more common in tumors such as gastric cancer,and MM with hyperamylasemia is clinically rare and has not been found in plateau areas.Due to the complex clinical manifestations of MM patients with hyperamylasemia,there is no standard treatment therapy.There is no literature report on the use of daretuumab in combination.Based on the results of the retrospective analysis of the first case of MM with hyperamylasemia in a plateau area,it is recommended that clinicians in plateau areas take amylase level as a sensitive indi-cator to evaluate the severity of MM in order to reduce the misdiagnosis rate of MM and provide a new treatment option for the promotion and application of MM with hyperamylasemia.

Multiple myeloma(MM)is a malignant plasmacyte disease that often presents with symptoms such as bone pain and anemia.Currently,there is an increasing number of literature re-ports on malignant tumors combined with hyperamylasemia,but this is more common in tumors such as gastric cancer,and MM with hyperamylasemia is clinically rare and has not been found in plateau areas.Due to the complex clinical manifestations of MM patients with hyperamylasemia,there is no standard treatment therapy.There is no literature report on the use of daretuumab in combination.Based on the results of the retrospective analysis of the first case of MM with hyperamylasemia in a plateau area,it is recommended that clinicians in plateau areas take amylase level as a sensitive indi-cator to evaluate the severity of MM in order to reduce the misdiagnosis rate of MM and provide a new treatment option for the promotion and application of MM with hyperamylasemia.

Objective:To construct a Discharge Preparation Service Demand Assessment Scale for Psychiatric Patients with Depression.Methods:Convenience sampling was used to select 25 experts from fields such as psychiatric nursing, psychiatric management, and rehabilitation treatment as the subject of the consultation. On the basis of literature review and clinical experience, the research group used the Delphi method to conduct two rounds of consultation with 25 experts, forming a Discharge Preparation Service Demand Assessment Scale for Psychiatric Patients with Depression. The enthusiasm of experts was evaluated using the effective response rate of the questionnaires. The authority level of experts was assessed using an authority coefficient. The concentration of expert opinions was evaluated using the mean of item importance assignment and coefficient of variation. The degree of coordination of expert opinions was represented by the Kendall coordination coefficient.Results:The effective response rates of the two rounds of consultation questionnaires were all 100%, with expert authority coefficients of 0.890 and 0.904, and the Kendall coordination coefficients of expert opinions of 0.247 and 0.203 ( P<0.05) . The Discharge Preparation Service Demand Assessment Scale for Psychiatric Patients with Depression was constructed, which included 10 dimensions and 38 items. Conclusions:The Discharge Preparation Service Demand Assessment Scale for Psychiatric Patients with Depression is scientific and reliable, which can provide a basis for clinical nurses to evaluate the discharge preparation service demands of psychiatric patients with depression.

Children have unique physiological and pathological characteristics, and their various system diseases are closely related to immune function, such as respiratory system, digestive system, nervous system, endocrine system, etc. These correlations are directly or indirectly related to the intestinal micro-ecosystem. In recent years, more and more study results show that as a major component of the human micro-ecosystem, the intestinal micro-ecosystem plays a decisive role in the important physiological functions of children such as immunity, metabolism, nutrition, etc. Children's intestinal micro-ecosystem is also associated with the treatment and prognosis of infectious diseases, chronic intestinal inflammatory diseases, allergic diseases, autoimmune diseases and metabolic diseases. In this paper, the related research of intestinal micro-ecology and some common diseases in pediatrics were summarized and discussed, the correlation between intestinal micro-ecology and pediatric diseases were deeply analyzed, in order to further understand the potential pathogenesis of pediatric diseases, and to provide new ideas for guiding the clinical treatment and long-term rehabilitation.

Objective:To explore the correlation between different smoking status and serum uric acid(SUA)in a middle-aged male in health check-up population.Methods:In this cross-sectional study, a total of 26701 middle-aged men who underwent health check-up in Taihu Sanatorium of Jiangsu Province from January 2014 to June 2015 were studied.The correlation between smoking status and SUA was analyzed by questionnaires, physical examination and serum biochemical assay.Smoking state was divided into no smoking, a occasional smoking and smoking groups.Results:With the increase of age, there was a downward trend of SUA( F=7.38, P=0.000). Among the three smoking groups, the group with occasional smoking had the highest level of SUA.The smoking group had lower level of SUA than the non-smoking group and occasional smoking group( P=0.000 and 0.005). In the non-smoking group, the fourth quartile of SUA(41.5%)had a higher percentage than that in first quartile of SUA(38.4%)( χ2=12.266, P=0.000). In the smoking group, the fourth quartile of SUA(54.9%)had lower percentage than that in the first quartile of SUA(58.4%)( χ2=7.049, P=0.008). Compared with the non-smoking group, the prevalence of hyperuricemia(HUA)in smoking group was lower( OR=0.872, 95% CI: 0.821~0.927, P=0.000), the prevalence of HUA in occasional smoking group was higher( OR=1.194, 95% CI: 1.013~1.408, P=0.035). Conclusions:As compared with the non-smoking group, the prevalence of HUA is lower in smoking group and is higher in occasional smoking group.