Objective To evaluate the effects and security of single or combined sufentanil application on sedation and analgesia for mechanically ventilated patients in intensive care unit(ICU).Method A total of 160 ICU patients with mechanical ventilation were randomly allocated into four groups:sufentanil group,sufentanil plus midazolam group,sufentanil plus dexmedetomidine group and fentanyl group.Facial pain scale(FPS),Ramsay score and vital signs were employed to assess the effects of different therapies on organ functions and adverse reactions.Result After the treatment,FPS in all groups were significantly decreased and maintained around 3 points.Ramsay scores were significantly increased(P <0.001)and the score in group given sufentanil combined with midazolam or dexmedetomidine at the time points of30 min,1 h,6 h were even higher.Compared with the preoperative data,indicators of lung function(PaCO2and blood lactic acid),liver function(AST)and renal function(Cr)were decreased in all groups(P <0.05).Respiratory rate in the fentanyl group was significantly higher than the others.Total consumption ofsufentanil in group with combined sufentanil application was significantly lower.No significant differencesin adverse reactions were noticed among the groups(P >0.05).Conclusion For mechanically ventilatedpatients,sufentanil has efficient sedative and analgesic effects with less physiological interference and severe adverse reactions.Combined application is beneficial in decreasing total sufentanil consumption andinhibition to respiratory system,which is worthy of being spread.

Objective To analyze the clinical typing, pathological classisfication, and prognosis of primary IgA nephropathy (IgAN).Methods Clinical typing, pathological classisfication and relationship between clinical manifestations and pathological features of 220 cases with IgAN were analyzed in 10 years.Results IgA nephropathy occupied 42.9％ (220/512) of all the patients received renal biopsy at the corresponding time.Asymptomatic abnormal urinalysis was the most common clinical manifestation(39.0％ (86/ 220)), followed by hypertension (17.7％ (39/220)) and recurrent macroscopic hematuria (15.4％ (34/220)).Grade Ⅲ pathological change(29.5％ (65/220)) was the most co mmon,followed by grade Ⅱ (27.3％ (60/ 220)) and grade Ⅳ (18.2％), Grade Ⅰ/Ⅴ were relatively less ((11.4％ (25/220), 13.6％ (30/220)).No correlation could be found between types of deposited immune complex and pathological lesion extent(x2=4.87, P＞0.05).The clinical manifestations were significantly correlated with the severity of glomerular lesions (x2 =13.14,P＜0.05).During the follow-up for 106 patients (mean duration of 23 months), 90 patients(84.9％) had normal renal function and 75 patients(70.8％) had decreased excretion of protein in urine (＜1 g/24 h).Conclusion The clinical typing of primary IgA is correlated with pathological changes.The prognosis of IgA is markedly correlation with the pathological lesion degree.Renal functions will be improved if the different treatments were given according to the different renal pathological features.

The authors expound the idea and service priorities of terminal care, making it clear that pain control and emotional support of relatives after the death of the patient are the major content of terminal care at present. They suggest that nursing in terminal care be implemented according to the situation of our country. Firstly, institutions for terminal care need to be established. Secondly, education of patients, their relatives and medical workers themselves regarding death ought to be strengthened. Thirdly, training in knowledge and skills of consolation should be conducted among nurses. And fourthly, nurses should be encouraged to cultivate noble moral sentiments, enhance training in clinical skills, receive education in psychology, and master nursing skills in psychology so as to do a good job of terminal care.

AIM: To analyze the characteristics of internal fixation implantation therapy for comminuted patella fracture. METHODS: A computer-based search of Pubmed database and Chinese Journal Full-text Database was undertaken, and the quotations of each literature were checked after the primary screening. Inclusion criteria: the papers about the application of internal fixation materials in comminuted patella fracture, those published in authority journals within recent five years were preferred. Exclusion criteria: repeated study or Meta analysis. RESULTS: Internal fixation approach differs as the fracture type. Tension band fixation is generally accepted to treat transverse patella fracture. Kirschner wire plus tension band fixation are inferior to transverse fixation, but in comminuted fracture it can induce more complications; despite of wide application, nickel titanium patella fixator is unsuitable for comminuted fractures due to its hypersensibility and carcinogenicity; silk or steel wire loop fixation fits various comminuted fractures, but metal cerclage is predisposed to induce infection and breakage because of insufficient fixation force. CONCLUSION: There is no common way for comminuted patella fracture therapy. Further researches on material and method which can cure all kinds of comminuted patella fracture are still needed.

The animal models of calcium oxalate stones induced by hyperoxaluria, hypercalciuria and lack of vitamin were summaried, and effects of different inhibitors and Chinese traditional medicines on the formation of calculi in animals were discussed.

Objective To explore the quality control method of leucodepleted red cell concentrate (LDRC) preparation ,to choice an optimal processing , in order to raise the quality of LDRC,so as to ensure the efficiency and safty for the preparation application.Methods 62 bag red cells concentrates suspensin(each 150ml,preparation from 200ml whole blood) were investigated.By linear regression multianalyzed the effects of some factors on efficiency for removal of leukocytes from red cell concentrates.Free hemoglobin value(n=8) was detected before and after leukodepleted filtration.1% samples were tested and bacterial cultured,and observed the clinical adverse effects after LDRC tranfusion.Results ⑴The plasma and platelet in red cell contentrate before filtration,the time of filtration had influence significantly on the result of leukocyte depletion.⑵The percentage of leukodepleted red cell in which residual leukocyte less than 5?10 6/unit and 1?10 6/unit were 100% and 46.9%. The percentage of leukodepleted red cell in which the leukocyte removal efficiency more than 2log(99%)and 3log(99.9%) were 100% and 56.1% .After controlling the time of filtration,the percentage of leukodepleted red cell in which residual leukocyte less than 1?10 6/unit was up from 46.9% to 90.91% and the percentage of leukodepleted red cell in which the leukocyte removal efficiency more than 3log(99.9%)/bag was up from 56.1% to 78.1%.⑶Red blood cell recovery rate was (90.48?4.73)%. There was no significant change of free hemoglublin before and after filtration.⑷No bacteria were detected by germiculture.⑸Evident side effects was no seen after transfusion.Conclusions During the course of removal of leukocytes from red cell concentrates by filtration, the sustained quality control is necessary for improving the quality of leukodepleted red cell.So enforcing aseptic manipulation rigorously and controlling the components of blood,the time of blood storage and filtration appropriately are quite important.

Objective To explore the clinical values of holter among different types of pacemaker postoperations .Methods Selected 120 patients undergoing pacemaker implantation from November 2013 to October 2014 ,who also received holter examina-tion after operation .The sensing and pacing dysfunction and pacemaker associated arrhythmia were analyzed according to their hol-ter results .Results In the DDD group ,the detection rate of the ventricular premature contraction ,the atrial premature contraction , the paroxysmal atrial tachycardia ,the paroxysmal atrial fibrillation and the paroxysmal supraventricular tachycardia were 38 .9% , 44 .4% ,8 .3% ,2 .8% and 2 .8% ,respectively .In the DDD group ,the detection rate of the sensing and pacing dysfunction and pace-maker associated arrhythmia was 69 .4% ,which was significantly higher ( P < 0 .05) than that in the VVI group (42 .5% ) ,the VVIR group(30 .0% ) ,the DDDR group(31 .3% ) and the AAI group(25 .0% ) ,respectively .In the VVI group ,the positive rate of the ventricular premature contraction ,the atrial premature contraction ,the paroxysmal atrial tachycardia ,the paroxysmal atrial fi-brillation and the paroxysmal supraventricular tachycardia were 37 .5% ,42 .5% ,10 .0% ,17 .5% and 2 .5% ,respectively .In the VVIR group ,the appearance rate of the ventricular premature contraction ,the atrial premature contraction and the paroxysmal atrial tachycardia were 25 .0% ,25 .0% and 5 .0% ,respectively .In the DDDR group ,the detectable rate of the ventricular premature con-traction ,the atrial premature contraction ,the paroxysmal atrial tachycardia and the paroxysmal atrial fibrillation were 31 .3% , 25 .0% ,12 .5% and 12 .5% ,respectively .Finally ,in the AAI group ,the detection rate of the ventricular premature contraction and the atrial premature contraction were 25 .0% each .Conclusion The clinical application of holter can evaluate the working states of different types of pacemakers ,and can monitor the sensing ,the pacing dysfunction and the pacemaker associated arrhythmia .

Objective To investigate the effect of health education on the willingness and knowledge about cervical examinations among fertile women.Methods Eight hundred fertile women visiting our hospitals for cervical examinations during January 2006 and December 2009 were managed with health education.Their willingness and knowledge about cervical examinations after the health education were compared with those before the education.Results The rate of willingness to take cervical examinations after the health education was significantly improved,compared to pre-health education(P<0.05).The scores on the knowledge about cervical cancer,impotence for health education,preventive method and regular cervical examinations after health education were all significantly improved compared to pre-education(all P<0.05).Conclusions Health education may significantly improve the willingness and knowledge about the cervical examinations among the fertile women.During health education,we should attach importance to the groups of high risks and adopt individualized and practical interventional strategies.

Objective To investigate the clinical value of MRI in the preoperative evaluation of breast cancer compared with mammography and ultrasonography. Methods A total of 35 patients with breast cancer were examined preoperatively with dynamic contrast enhanced MRI, mammography and ultrasonography. The findings were evaluated and compared with surgical biopsy. Results The detection rates of breast cancer with MRI, mammography and ultrasonography was 100%, 74.29% and 82.86%, respectively. MRI, mammographic and ultrasonographic measurement of tumor size had correlation coefficient to pathologic findings (r=0.94, 0.87, 0.70, respectively). The sensitivity, specificity, and accuracy of detection of intraductal spread of MRI, mammography and ultrasonography was 100%, 80.00% and 88.57% (P＜0.05), 66.67%, 95.00% and 82.86% (P＞0.05), 33.33%, 95.00% and 68.57% (P＞0.05), respectively. Conclusion MRI can detect breast cancer, especially intraductal spread more sensitively than mammography and ultrasonography.

Objective Ouabain is a cardiotonic steroid that can induce the apoptosis of many tumorous cells .This study was to investigate the anti-tumor mechanisms of ouabain by observing its effects on the apoptosis of T lymphoblastic leukemia Jurkat cells and the expressions of hTERT and c-myc mRNA and protein . Methods Jurkat cells were treated with ouabain at the concentrations of 50 and 100 nmol/L for 24 and 48 hours, and those treated with 1 ×PBS served as the control .Then the apoptosis rate of the cells was detected by flow cytometry after Annexin V/PI staining, the expressions of hTERT and c-myc mRNA determined by RT-PCR, and those of hTERT and c-myc protein by Western blot . Results The apoptosis rates of the Jurkat cells in the 50 and 100 nmol/L oua-bain groups were (5.67 ±3.71)%and (9.63 ±4.83)%respectively at 24 hours, and (19.67 ±4.55)%and (37.60 ±11.89)%at 48 hours, significantly higher than (4.23 ±1.01)%in the PBS control group at 48 hours (P<0.05).Compared with the control, the expressions of hTERT and c-myc mRNA were decreased by 200%and those of hTERT and c-myc protein by 224%and 400%, re-spectively, at 48 hours (P<0.05).There was a positive correlation between the reduction of the mRNA levels and that of the protein levels of hTERT and c-myc (P<0.05). Conclusion Ouabain can down-regulate the mRNA and protein expressions of hTERT and c-myc, which may be one of the mechanisms of its induction of the apoptosis of Jurkat T lymphocyte leukemia cells .