Objective:To evaluate the effect of repeated intranasal insulin on postoperative delirium (POD) in elderly patients undergoing general anesthesia.Methods:Seventy elderly patients, aged ≥65 yr, with body mass index ≤28 kg/m 2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, undergoing elective radical gastrectomy for gastric cancer under general anesthesia, were divided into 2 groups ( n=35 each) according to the random number table method: control group (group C) and insulin group (group I). In group C, normal saline 0.5 ml was administered intranasally twice a day from 2 days before surgery until the day of surgery.In group I, insulin 20 U (0.5 ml) was administered intranasally twice a day from 2 days before surgery until the day of surgery.The regional tissue oxygen saturation (rSO 2) was measured after entering the operating room (T 0), at intubation (T 1), at 1, 2 and 3 h after the start of operation (T 2-4), at the end of surgery (T 5) and at extubation (T 6). The insulin allergic reactions, nasal irritation and hypoglycemic reactions were recorded after intranasal administration of insulin or normal saline within 2 days before operation.The blood glucose concentrations were measured at T 0, T 3 and T 5.The occurrence of POD within 3 days after operation was recorded. Results:Compared with group C, the incidence of POD was significantly decreased within 3 days after operation, and the rSO 2 was increased at T 1-6 in group I ( P<0.05). The rSO 2 was significantly higher at T 1-6 than at T 0 in two groups ( P<0.05). There were no significant changes in blood glucose concentrations at T 0, T 3 and T 5 between the two groups ( P>0.05). No insulin allergic reactions, nasal irritation and hypoglycemic reactions occurred in two groups ( P>0.05). Conclusion:Repeated intranasal administration of insulin can increase the rSO 2 during operation and decrease the occurrence of POD in elderly patients undergoing radical gastrectomy for gastric cancer.

As the diagnosis and treatment levels increased, the cure rate and lifetime of the patients with breast cancer improved. In China,surgery and drug treatment received more attention, but the overall rehabilitation was ignored. This article summarized the status of breast cancer patients's rehabilitation in lymphoedema, upper limb dysfunction, psychological problem, sexual dysfunction, childbirth trouble,dystrophy, follow-up visit and family-society support, and so on.

AIM:To establish a kind of simple and efficient method for cell-free fetal DNA ( cff-DNA) enrich-ment and to investigate its range of applications and the advantages and disadvantages.METHODS:(1) The single nucleo-tide polymorphisms( SNPs) , which linked to paternalβ-thalassemia mutations, were screened.We analyzed the contact be-tween the SNPs inβ-thalassemia gene ( HBB gene) and haploid type by the Haploview software, and then selected these close SNPs which have higher heterozygosity with the HBB gene.(2) We selected 4 cases of different β-thalassemia muta-tions with their husband, and then we used TT-FAST-COLD-PCR to enrich the IVS-II-654 mutations in maternal plasma.If the IVS-II-654 mutation was not detected, we detected the SNP which linked to the IVS-II-654 mutation.Similarly, we used TT-FULL-COLD-PCR to enrich the CD41-42 mutations in the maternal plasma.At the same time, we used the conventional PCR to enrich CD41-42 mutation and IVS-II-654 mutation in the maternal plasma.RESULTS:(1) Nine cases of the SNP ( rs7480526) linked to the mutation at IVS-II-654 in HBB gene, and 11 cases of the SNP ( rs10768683) linked to the muta-tion at CD41-42 in HBB gene were detected.( 2 ) We detected 1 case who inherited the paternal β-thalassemia mutation (IVS-II-654).We did not directly detect patermal IVS-II-654 mutation in maternal plasma, but detected the SNP linked to the IVS-II-654 mutation in the other case and had 100%detection, and 2 cases inherited the paternal β-thalassemia muta-tions (CD41-42) in the maternal plasma by TT-FULL-COLD-PCR and had 100%detection.However, we detected nothing by conventional PCR.CONCLUSION:TT-COLD-PCR is applicable to enrich cell-free fetal DNA in maternal plasma and is a method in the field of noninvasive prenatal diagnosis.

Objective To explore the application values and the effect of myocardial preservation of right stellate ganglion block in off-pump coronary artery bypass grafting (OPCABG). Methods Sixty-two patients with ASA Ⅱ or Ⅲ,aged 50-75 years,scheduled for OPCABG were randomly divided into stellate ganglion block group (group SGB)and control group (group C)with 31 cases each.The patients in group SGB received right-lateral SGB before anesthesia induction.The medications and methods of anesthesia induction in the two groups were identical.Hemodynamics be-fore start of anethesia (T0 ),after induction (T1 ),after intubation tube (T2 ),after sternotomy (T3 ),at the beginning of bypass surgery for interrupted coronary artery (T4 ),at the end of coronary bypass grafting (T5 )were observed.Meanwhile,changes of serum cardiac troponin I (cTnI)and cre-atine phosphokinase MB (CK-MB)at T0 ,6 h (T6 ),12 h (T7 ),24 h (T8 )after operation were also observed.The operative time,the amount of drugs used and postoperative recovery were recored. Results MAP,HR of group SGB increased at T2-T5 compared with T0 ,and MAP,HR of group C significantly increased at T2-T5 comparing with T0 (P <0.05).Compared with those in group SGB, MAP,HR significantly increased at T2-T5 in group C (P <0.05 ).The Concentrations of cTnI and CK-MB of group C increased more obviously than those in group SGB at T6-T8 (P <0.05).Compared with group C,patients in group SGB needed less medication,less hospitalization time in ICU and had faster postoperative recovery.Conclusion SGB for patients during OPCABG stabilizes hemodynamy stability,further reduces myocardial injury,thus protecting myocardium.

objective To explore the effect of diabetes management program with the goal of behavior changes on behavior change and metabolic index of patients with type 2 diabetes mellitus.Methods By setting up the diabetes management team,establishing personalized management file,carrying out education program,setting the goal of behavior changes and evaluating goal's trace,One-year management was carried out for 56 cases of type 2 diabetic patients.Patients' behavior changes were evaluated after six months management and one year later the metabolic indexes were contrasted.Results After 6 months management,the rate of goal achievement was 96%,the rate of one year behavior stabilization was 92%,the body mass index (BMI),fasting and postprandial blood glucose,glycosylated hemoglobin (HbAlc) one year later were decreased dramatically.Conclusions There is important significance of diabetes management program with the goal of behavior changes for behavior changes and metabolic indexes control in type 2 diabetic patients.

To analyse and compare the characteristics of the intestinal absorption of puerarin, baicalin, berberine and liquiritin in different combinations of Gegenqinlian decoction based on pharmacokinetic parameters, a sensitive liquid chromatography-tandem mass spectrometric (LC-MS/MS) method was applied for the quantification of four components in rat's plasma. And pharmacokinetic parameters were determined from the plasma concentration-time data with the DAS software package. The influence of different combinations on pharmacokinetics of four components was studied to analyse and compare the absorption difference of four components, together with the results of the in vitro everted gut model and the rat single pass intestinal perfusion model. The results showed that compared with other combinations, the AUC values of puerarin, baicalin and berberine were increased significantly in Gegenqinlian decoction group, while the AUC value of liquiritin was reduced. Moreover, the absorption of four components was increased significantly supported by the results from the in vitro everted gut model and the rat single pass intestinal perfusion model, which indicated that the Gegenqinlian decoction may promote the absorption of four components and accelerate the metabolism of liquiritin by the cytochrome P450.

Objective To explore the change of sexual life quality and its influencing factors of premenopausal breast cancer patients.Methods 94 premenopausal breast cancer patients were included. Changes in Sexual Functioning Questionnaire short-form (CSFQ-14) was used and part of its items was changed. Their sexual life was evaluated before and after treatment by using depth interview and anonymous methods. Results 94 cases received face-to-face communication and study. 88 (93.6%) questionnaires were received, in which 81 (92.1%) questionnaires were effective. Their sexual life quality and sexual satisfaction significantly decreased and there was significant difference in the CSFQ-14 score (P<0.001) before and after treatment. The ratio of bad, worse, and worst sexual life were 39.5%, 29.6%, and 14.8% respectively after treatment. 65.4% of the patients had no sexual activity. The reasons included medical related factors, fear of cancer metastasis and recurrence, physical discomfort, poorer body image, partner sexual attitudes changed, life stress, common psychological problems, traditional ideas and so on. Conclusion Sexual dysfunction was obvious and sexual life quality significantly decreased in premenopausal breast cancer patients after treatment. Patients' physical and mental damage, the change of body image and spouse's attitude are significant influencing factors. It is necessary to give sexual rehabilitation guidance to patients and their spouses.

Objective:To investigate the effect of a 2-year resistance and aerobic training on reducing the risk of cardiovascular disease in patients with prediabetes.Methods:A total of 248 patients with prediabetes were enrolled from Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from January to April 2014, and Danyang People′s Hospital and The First Affiliated Hospital of Guangxi Medical University from May to December 2014.Based on random number table method, the patients were divided into 3 groups: the resistance training group (RT group, 82 cases), the aerobic training group (AT group, 83 cases) and control group (83 cases). Participants in the RT group and the AT group underwent a total of 24 months of exercise training. Changes in indicators (blood glucose,blood lipid, etc.) at baseline and the end of 12 and 24 months among the groups were compared.Results:After intervention, glycosylated hemoglobin (HbA1c), low density lipoprotein cholesterol (LDL-C), blood pressure and homeostasis model 2 insulin resistance index (HOMA2-IR) in the RT and AT groups tended to decrease, and the steady state model 2 β cell function index (HOMA2-β) tended to increase. At the end of 24 months, HbA1c [5.80 (5.43, 6.20) %, 5.70 (5.50, 6.00)% vs. 6.20 (5.70, 6.60) %, all P≤ 0.01], LDL-C [3.07 (2.69, 3.58) mmol/L, 2.97 (2.62, 3.95) mmol/L vs. 3.21(2.54, 3.78) mmol/L, all P<0.05] and HOMA2-IR [0.96 (0.82, 1.47), 1.20 (0.99, 1.43) vs. 1.34 (1.09, 1.51), all P<0.05] were significantly decreased in the RT and AT groups than in the control group. In addition, HOMA2-β [84.50 (60.55, 107.33), 93.00 (78.60, 119.75) vs. 53.40 (37.70, 80.40), all P = 0.001] was significantly increased in the AT and RT groups compared with that in the control group. There were no significant differences in triglyceride (TG) and high-density lipoproteincholesterol (HDL-C) levels between the training groups and the control group (all P>0.05). After adjusting for age, sex and blood pressure, the cardiovascular risk of prediabetes was significantly reduced in RT ( P =0.017) and AT groups ( P =0.018). The Cox regression analyses showed that both the resistance training (HR=0.419, 95 %CI =0.415-0.942, P=0.037) and the aerobic training ( HR=0.310, 95 %CI=0.447-0.866, P=0.026) were protective factors for cardiovascular disease in prediabetic patients after adjustment of age, sex, statins, body mass index and waist-to-hip ratio, which reduced the risks of cardiovascular disease in prediabetic patients by 58.1% and 69.0%, respectively. Conclusions:Two years of aerobic and resistance training interventions have obvious advantages on glycemic and insulin resistance control in prediabetes patients. The resistance training can reduce the risk of cardiovascular disease, and it is, thus, recommended for prediabetic patients without obvious exercise contraindications.

Shanghai East Hospital has built a general practice residency training information system based on "Internet +" technology since 2017. This training system effectively promoted the training quality, improved the clinical and research ability of general practitioners, and strengthened the supervision of the training. It has improved the training satisfaction, increased passing rate of national medical licensing examination and graduation comprehensive examination of trainees. This training system can largely break the time and space limitations, and has strong replicability. It may provide reference to optimize the general practice standardized residency training for other institutions.

Objective:To compare the dosimetric difference between knowledge-based planning (KBP) volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) models for predicting the dose distribution during IMRT, aiming to investigate the feasibility of VMAT model to predict the IMRT plans.Methods:Fifty prostate cancer patients who had completed radiotherapy were selected. Manual planning was performed on each selected patient to generate the corresponding IMRT and VMAT plans. The IMRT and VMAT manual plans of the 40 randomly-selected patients were adopted to generate the KBP VMAT and IMRT models. The remaining 10 patients were utilized to predict IMRT plans. VMAT library-derived IMRT model (V-IMRT) and IMRT library-derived IMRT model (I-IMRT) were generated. Dosimetric parameters related to organ-at-risks (OARs) and planning target volume (PTV) were statistically compared among the manual IMRT (mIMRT), V-IMRT and I-IMRT plans.Results:Compared with the mIMRT plan, I-IMRT could significantly better control D max of the PTV ( P=0.039), whereas V-IMRT and I-IMRT plans could better protect the bladder and bilateral femoral heads (both P<0.05). V-IMRT plan could better protect the D max of bilateral femoral heads and the D 15% of the right femoral head (both P<0.05), whereas no significant difference was observed in other OARs and PTV (all P>0.05). Conclusions:Compared with the manual plans, KBP IMRT plan has significant advantages in protecting the OARs. KBP VMAT and IMRT models are both feasible in clinical practice, which yield equivalent accuracy for predicting IMRT plan.