lymorphism of CD14 gene is a risk factor for diabetic nephropathy.

Objective To study the clinical effects of postpartum haemorrhage and the clinical effects of psychosocial intervention. Methods Choose 88 cases, patients treated in our hospital, it can be divided into two groups, respectively using oxytocin combined conventional nursing mother, yan pei combined psychological intervention treatment, analysis its therapeutic effect. Results The curative effect of observation group of patients, postpartum haemorrhage amount and quality of life, each index significantly better than the control group, the changes of its data through comparison between groups, differences, statistically significant(P<0.05). Conclusion The patients with postpartum haemorrhage, with the treatment of the psychological intervention and the treatment of the psychological intervention, the effect is good.

ObjectiveThe aim of this study was to investigate the professional cognitive level and its influencing factors of fresh nursing students in Yunnan,in order to provide a basis for nursing education workers, improve the situation and put forward a series of interventions.MethodsA questionnaire survey was done among 623 fresh nursing students in 5 universities of Yunnan province,and the data were collected and analyzed using the descriptive analysis and chi-square test of software SPSS22.0.Results There were 313 peoples choose nursing for easy future employment in qualified 599 questionnaires. The professional cognitive level in Yunnan was not comprehensive compared with other provinces,and the ratio of the nursing mission and etc were lower than other provinces with statistical significance(P < 0.05). However,there were 50 people(40.98%)would like to choose other major of 122 people who come from other provinces,which was higher than that of Yunnan (34.98%). There were 324 students(63.11%)were proud of nursing,327 students(63.70%)think nursing have a good development prospect who received the freshmen entrance education,which were higher than 35.62% and 42.47% of who could not receive the freshmen entrance education,with a statistical significance(P < 0.05). ConclusionSchool should reinforce the new students entrance education and professional publicity to cultivate the professional emotion of nursing freshmen.

Objective To evaluate the treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.Methods From January 2014 to January 2017,26 patients were operatively treated at Department of Orthopaedics,Tongji Hospital for posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.They were 10 men and 16 women,aged from 53 to 67 years(average,61.5 years).The surgery was conducted in prone position via the posterolateral and posteromedial approaches to expose simultaneously the fractures ends at medial,lateral and posterior malleoli for open reduction.The lateral malleolar fractures were fixated with plate,the medial malleolar fractures with screws and posterior malleolar fractures with plate or cannulated screws depending on the size of the fracture blocks.The outcomes were assessed using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS) and the visual analogue scale(VAS).Results Of this cohort,22 were followed up for 30 months on average(range,from 18 to 48 months).All the cases healed by the first intension without any infection.Their postoperative X-ray showed bone union after an average of 12.5 weeks(range,from 10 to 15 weeks).No nonunion,loosening or breakage of implants was found.The mean time for walking with full weight-bearing was 13 weeks(range,from 11 to 16 weeks).Their AOFAS ankle-hindfoot scores at the final follow-ups were 85.4(range,from 80 to 92),yielding 13 excellent and 9 good cases with a good to excellent rate of 100%.Their mean VAS scores were decreased significantly from preoperative 8.6±0.6 to postoperative 1.7±0.3(f=153.000,P=0.000).Conclusion In treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures,a combination of posterolateral and posteromedial approaches in prone position can expose and reduce simultaneously the fractures ends at medial,lateral and posterior malleoli,leading to satisfactory clinical outcomes.

Objective:To determine the 50% effective dose (ED 50) of sugammadex for rapid recovery of the signal of intraoperative neuromonitoring of recurrent laryngeal nerve in radical thyroidectomy. Methods:American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, weighing 40-90 kg, scheduled for elective radical thyroidectomy under intraoperative neuromonitoring of recurrent laryngeal nerve, were enrolled in this study.Sufentanil and propofol were intravenously injected, and muscle relaxation monitoring was performed after the patients lost consciousness.Rocuronium 0.6 mg/kg was intravenously injected, and tracheal intubation was performed when the twitch ratio was 0.The infusion rate of rocuronium was adjusted to maintain twitch ratio 0-10%.When the signal needed to be detected, rocuronium infusion was stopped, sugammadex was injected intravenously using up-and-down sequential method, with the initial dose of 2 mg/kg.If a stable signal was detected within 3 min, the concentration decreased by 0.2 mg in the next patient, otherwise the concentration increased by 0.2 mg in the next patient.The Dixon and Massey formula was used to calculate the ED 50 and 95% confidence interval of sugammadex. Results:The ED 50 of sugammadex for the rapid recovery of the signal of intraoperative neuromonitoring of recurrent laryngeal nerve was 0.98 mg/kg, and the 95% confidence interval was 0.94-1.02 mg/kg during radical thyroidectomy. Conclusion:The ED 50 of sugammadex for rapid recovery of the signal of intraoperative neuromonitoring of recurrent laryngeal nerve is 0.98 mg/kg in radical thyroidectomy.

Objective:To evaluate the relationship between preoperative sarcopenia and severe pulmonary complications after cardiac surgery in elderly patients.Methods:Elderly patients undergoing elective open heart surgery in our hospital were collected and divided into non-sarcopenia group and sarcopenia group, according to the diagnostic criteria updated and revised by the Asian Sarcopenia Working Group in 2019. The outcome measure was the development of severe postoperative pulmonary complications (PPCs). The general information of patients and various indexes of surgical conditions were recorded. Risk factors for severe PPCs were identified by multivariate logistic regression analysis. The accuracy of sarcopenia score, American Society of Anesthesiologists (ASA) Physical Status classification, and combination of ASA Physical Status classification and sarcopenia score in predicting severe PPCs was assessed using the receiver operating characteristic curve.Results:A total of 158 patients were finally enrolled, including 36 patients with sarcopenia (22.7%), and the incidence of severe PPCs was 22.2%. Multivariate logistic regression analysis showed that ASA classification, sarcopenia, and duration of surgery were independent risk factors for severe PPCs after cardiac surgery in elderly patients ( P<0.05), and the risk of severe PPCs was approximately 3.21 times higher in sarcopenic patients than in non-sarcopenic patients. The area under the receiver operating characteristic curve of sarcopenia score, ASA Physical Status classification, and ASA Physical Status classification combined with sarcopenia score in predicting severe PPCs were 0.686 (95% confidence interval [ CI] 0.607-0.757), 0.603 (95% CI 0.522-0.680), and 0.714 (95% CI 0.637-0.783), respectively. Conclusions:Preoperative sarcopenia is an independent risk factor for severe PPCs after cardiac surgery in elderly patients, and the preoperative sarcopenia in combination with ASA Physical Status classification in predicting severe PPCs has a certain accuracy.

Objective: To observe the material basis and mechanism of action of Kai-Xin-San (KXS) in regulating antidepression of neurotrophic factors. Methods: KXS eluted by ethanol on macroporous resin was prepared. The antidepressive effect of different components was compared by tailing suspension test and forced swimming test of mice. The levels of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in hippocampus were determined by ELISA. The rat astrocyte glioma C6 cell line and the rat adrenal pheochromocytoma PC12 cell line were used to evaluate the effects of different ethanol elution sites on the expression of NGF and BDNF and the differentiation of PC12 cells.Results: All of the ethanol elution components from KXS exerted anti-depressive effects by shorting the immobile time of tailing suspension and forced swimming of mice and 70％ ethanol elution components exerted best efficacy. This site also could increase expressions of NGF and BDNF on C6 glioma cell line. The 10％ ethanol elution site had the strongest ability to promote PC12 cell differentiation. Ginsenosides were the main effectuve ingredients for promoting the expression of neurotrophic factors. Conclusion: Regulation of neurotrophic factors might be the prominent action mechanism of KXS exerting anti-depressive effects.

Objective To investigate the independent association of serum Fetuin-B with metabolic syndrome in obese Chinese adults.Methods Cross-sectional data on socio-demographic,lifestyle,clinical characteristics, and serum Fetuin-B were collected for 1 318 Chinese adults with central obesity.Associations of serum Fetuin-B with metabolic syndrome and insulin resistance were analyzed using multivariable Logistic regression analysis.Results A total of 820(62.2%)individuals were identified as metabolic syndrome.Subjects with metabolic syndrome showed significantly increased levels of serum Fetuin-B than those with non-metabolic syndrome[(4.18 ±1.39 vs 4.02 ± 1.35)μg/ml,P=0.043].Increased serum Fetuin-B were significantly associated with increased fasting plasma glucose and insulin levels, as well as prevalences of non-alcoholic fatty liver disease(NAFLD)and insulin resistance.After adjustment for potential confounders, serum Fetuin-B was significantly associated with increased risks of metabolic syndrome and insulin resistance(OR=1.19,95%CI 1.06-1.34,P=0.004;OR=1.15,95%CI 1.01-1.30,P=0.031 respectively).Conclusion Serum Fetuin-B level was significantly associated with NAFLD;and elevated serum Fetuin-B was significantly associated with increased risk of metabolic syndrome.

Objective To determine the minimum alveolar concentration (MAC)of sevoflurane for blunting the responses to surgical incision in 50% adult patients diagnosed as gastric carcinoma and treated with neoadjuvant chemotherapy.Methods Twenty-five ASA physical statusⅠor Ⅱ,and aged 30-50 years patients (14 males and 11 females)diagnosed with gastric carcinoma were enrolled.At least 1 month before the operation,all these patients received 2 cycles (1 chemotherapy cycle was 14 days)of chemotherapy including oxaliplatin and tegafur.At first,the anesthesia induc-tion was started by inhaling 6% sevoflurane.After the patient lost consciousness,the endotracheal in-tubation was performed.And then,the end tidal sevoflurane concentration was adjusted to the target concentration and maintained stable for 15 min.After that,the surgical incision was executed.The Dixon's up-and-down method was used to calculate the MAC.The initial end tidal sevoflurane con-centration was 2.2% and it was increased or decreased by 0.2% in the next patient according to the surgical incision response.If the surgical incision response was positive,the end tidal sevoflurane con-centration was increased;if the surgical incision response was negative,the end tidal sevoflurane con-centration was decreased.The midpoint from negative response to positive response was set as the balance point and the mean value of the concentrations of sevoflurane at all the balance points were calculated as MAC.Results Minor physical activity occurred when the surgical incision started.No body twisting,eye opening or intraoperative awareness occurred.Body moving occurred in 11 patients (44%)when the surgical incision started.The end tidal sevoflurane concentration for blunting the re-sponses to surgical incision in 50% adult patients diagnosed as gastric carcinoma and treated with neo-adjuvant chemotherapy was 1.52%,and the 95% CI was 1.37%-1.65%.Conclusion The MAC of sevoflurane for blunting the responses to surgical incision in 50% adult patients diagnosed as gastric carcinoma and treated with neoadjuvant chemotherapy is 1.52%.

Objective:To evaluate the accuracy of ultrasound-measured pulsatility index (PI) of central retinal arteries in diagnosing low cerebral perfusion pressure (CPP) in the patients with traumatic brain injury.Methods:Fifty-five patients who were admitted to the surgical intensive care unit due to traumatic brain injury with continuous intracranial pressure monitoring were selected.At 72 h after surgery, continuous incracranial pressure and mean arterial pressure were recorded, and peak systolic velocity and end diastolic velocity of central retinal arteries were measured by ultrasound.The invasive CPP and PI were calculated.The correlation between PI and CPP was analyzed.The accuracy of central retinal pulse index in diagnosing low CPP was evaluated by the receiver operating characteristic curve.Results:PI was negatively correlated with CPP ( r=-0.655, P<0.01). The area under the receiver operating characteristic curve of PI in diagnosing low CPP was 0.863 (95% confidence interval 0.761-0.965), and the threshold value was 0.97, sensitivity 92.3%, and specificity 66.7%. Conclusion:Ultrasound-measured PI is more accurate in diagnosing low CPP in the patients with traumatic brain injury.