Objective To evaluate the effects of dexmedetomidine on the hemodynamics and the heart rate variability(HRV)in patients under-going lower limbs operations with application of tourniquet. Methods Forty patients undergoing lower limbs operations with application of tourni-quet were randomized assigned to dexmedetomidine group(group D,n=20)or control group(group C,n=20). After combined spinal-epidural anesthesia,group D received a continuous infusion of dexmedetomidine(0.5μg/kg for 10 min for loading dose and followed by 0.2μg·kg-1·h-1) until tourniquet deflation. The control group received normal saline instead. Mean arterial pressure(MAP),heart rate(HR),saturation of pulse ox-imetry(SpO2),low frequency power(LF),high frequency power(HF)and LF to HF ratio(LF/HF)were recorded at regular time points:imme-diately before loading dose(T0),before tourniquet inflation(T1),15 min after tourniquet inflation(T2),30 min after tourniquet inflation(T3),45 min after tourniquet inflation(T4),60 min after tourniquet inflation(T5),1 min after tourniquet deflation(T6),5 min after tourniquet deflation (T7)and 10 min after tourniquet deflation(T8). Results Compared with T0,the MAP of group D significantly decreased at T6-T8(P<0.05). Compared with T0 and T1,the MAP of group C increased at T2-T5(P>0.05). Compared with T2-T5,the MAP of group C significantly decreased at T6(P<0.05). Compared with group C,the MAP of group D significantly decreased at T6 and T7(P<0.05). Compared with T0,the HR of group D significantly decreased at T1-T8(P<0.05). Compared with T0,the HR of group C had no significant change at T1-T5(P<0.05). Compared with T1-T5,the HR of group D and group C significantly increased at T6(P<0.05). Compared with group C,the HR of group D significantly decreased at T1-T4 and T6(P<0.05). Compared with T0,the SpO2 of group D and group C significantly decreased at T6(P<0.05). Compared with group C,the SpO2 of group D significantly decreased at T1-T3(P<0.05). Compared with T6,LF of group D and group C significantly increased at T7(P<0.05). LF were comparable between groups D and C(P>0.05). Compared with T0,the HF of group D significantly increased and the LF/HF of group D significantly decreased at T1-T4(P<0.05). Compared with group C,the HF of group D significantly increased and the LF/HF of group D significantly decreased at T1-T4(P<0.05). Conclusion The appropriate dose of dexmedetomidine(loading dose 0.5μg/kg and maintenance dose 0.2μg · kg-1 · h-1)can significantly increase vagal tone and improve cardiac sympathetic and parasympathetic balance during tourniquet appli-cation.

Objective To observe the clinical curative effect of Gubenzhike granule on cough variant asthma (CVA), and explore its mechanism. Methods A total of 140 cases of CVA were randomly divided into two groups, 70 cases for each group. The treatment group took Gubenzhike granule orally, and the control group inhaled Budesonide Powder for Inhalation and Salbutamol Sulphate Aerosol, respectively for 8 weeks, with 8 weeks follow-up after treatment. The same nursing intervention was implemented in two groups. Cough symptom scores of the two groups were observed after treatment and at the end of follow-up, the number of eosnophils (EOS) and content of immunoglobulin E (IgE) in peripheral blood were also observed. Results The treatment group completed 67 cases and the control group completed 66 cases. After treatment, the cough symptom scores, EOS and IgE in two groups were significantly reduced (P<0.01, P<0.05), and the cough symptom score of treatment group decreased more significantly than that of control group (P<0.01). The total effective rate and recurrence rate were 91.04%and 9.84%in treatment group, and 83.33% and 30.91% in control group. The total effective rate of treatment group was better than the control group (P<0.01), and the recurrence rate was lower than the control group (P<0.01). Conclusion Gubenzhike granule showed significant effect and low recurrence rate on CVA. Good anti-inflammatory and antianaphylaxis effects may be one of its mechanisms.

Objective To explore the feasibility , necessity and teaching content of integrated traditional Chinese medicine and western medicine nursing education in Adult Nursing curriculum, and to provide the basis of building the content of textbook on the integrated traditional Chinese medicine and western medicine in Adult Nursing.Methods One hundred and sixty experts , who were chief editors , deputy editors and editors and attended the meeting to compile the nursing textbook for National Traditional Chinese Medicine University in August 14-16th, 2011 in Hangzhou, were surveyed by self-designed questionnaire .Results Thinking that Chinese nurses should receive the traditional Chinese medicine nursing education accounted for 80%;Thinking that carrying out the integrated traditional Chinese medicine and western medicine nursing in the clinical practice was necessary accounted for 93.1%;Thinking that clinical nursing course should combine with the knowledge of integrated traditional Chinese medicine and western medicine nursing accounted for 73.8%; Thinking that clinical nursing course should be integrated into the health preserving of traditional Chinese medicine and preventive health care knowledge accounted for 88.7%.Thinking that the disease kinds which fitted to combine with more than 50%of knowledge of integrated traditional Chinese medicine and western medicine nursing were 44 in the common diseases of medicine and surgery .Conclusions The content of textbook on Adult Nursing should combine with the knowledge of integrated traditional Chinese medicine and western medicine nursing , and that is feasibility and necessity .

To explore influence of Xinmailong injection on cardiac function and vascular endothelial func‐tion in advanced aged patients with acute myocardial infarction (AMI) heart failure (HF).Methods : A total of 122 advanced aged AMI‐HF patients treated in our hospital from Mar 2015 to Jul 2017 were selected ,randomly and e‐qually divided into routine treatment group (received routine anti‐HF medication ) and Xinmailong group (received Xinmailong injection based on routine treatment group ) ,both groups were treated for 10d and then followed up for six months .LVEF ,wall motion score index (WMSI) ,serum levels of BNP , hsCRP , cTnI ,nitric oxide (NO) ,en‐dothelin (ET)‐1 and inner diameter of brachial artery were observed and compared between two groups before and after treatment .Results : Compared with before treatment ,there were significant rise in LVEF [routine treatment group : (35.42 ± 5.11)% vs. (44.62 ± 5.88)%;Xinmailong group : (36. 13 ± 5.64)% vs. (49.75 ± 6. 18)%] and serum NO level [routine treatmentgroup : (108. 35 ± 21.67) μmol／L vs. (129.68 ± 25. 83 ) μmol／L ; Xinmailong group : (110.26 ± 22.71) μmol／L vs. (156.82 ± 24. 19) μmol／L] ,and significant reductions in WMSI [routine treatment group : (2.49 ± 0.51) score vs. (1.45 ± 0.34) score ; Xinmailong group : (2.51 ± 0.42) score vs. (1. 12 ± 0.27) score] ,NYHA class (routine treatment group :3.19 ± 0. 44 vs. 2.65 ± 0.36 ;Xinmailong group :3. 21 ± 0.42 vs. 2.11 ± 0.28) ,serum levels of BNP [routine treatment group : (986. 72 ± 245.63 ) pg／ml vs. (764.42 ± 217.33) pg／ml ; Xinmailong group : (989.99 ± 243. 54 ) pg／ml vs. (607. 82 ± 198. 65 ) pg／ml ] , hsCRP [routine treatment group : (24.31 ± 3.82) mg／L vs. (14.52 ± 1. 69 ) mg／L ; Xinmailong group :(24.93 ± 3.74) mg／L vs. (7. 81 ± 0. 96) mg／L] ,cTnI [routine treatment group :(5.29 ± 0.43) μg／L vs. (3.01 ± 0. 27) μg／L ;Xinmailong group :(5.37 ± 0.64) μg／L vs. (1.42 ± 0.33) μg／L ] and ET‐1 [routine treatment group :(95. 67 ± 16. 32) ng／L vs. (76. 34 ± 17.82) ng／L ;Xinmailong group :(96.13 ± 17.21) ng／L vs. (57.29 ± 14. 63) ng／L] in two groups ;and LVEF and serum NO level of Xinmailong group were significantly higher than those of routine treatment group , WMSI ,NYHA class ,serum levels of BNP ,hsCRP ,cTnI and ET‐1 of Xinmailong group were significantly lower than those of routine treatment group , P＝0.001 all.Compared with before treatment ,there were significant rise in reactive hyperemia brachial diameter (Dhyperemia ) , fore brachial artery endothelium dependent diastolic‐systolic function (FMD) in Xinmailong group after treatment , and they were significantly higher than those of routine treatment group , P＜0. 05 or ＜0. 01 .Conclusion : Xinmailong injection can significantly improve cardiac function and vascular endothelial function in AMI‐HF patients ,which is worth extending .

OBJECTIVETo evaluate the ability of Biopure MTAD in removing smear layer in vitro.

METHODSForty extracted single-rooted human teeth were randomly divided into five groups: Distilled water in group A, 5.25% NaClO and 17% EDTA in group B, 1.3% NaClO in group C, 1.3% NaClO and Biopure MTAD in group D, 1.3% NaClO and 3% EDTA in group E. The canals were prepared and irrigated with one of the five different irrigating agent respectively. The amount of smear layer and erosion on the surface of the root canal walls were examined with scanning electron microscope.

RESULTSThe whole surfaces of root canals in group A and C were covered by smear layer. The surfaces of root canals in the coronal and middle thirds of samples in group B, D, E were free of smear layer (P>0.05) and the apical third of canals in the group D were significantly cleaner (P<0.05) than that in group B and E. The coronal and middle sections were significantly eroded in group B compared with group D and E (P<0.05). The degree of erosion in the apical section was not statistically different among group B, D and E (P>0.05).

CONCLUSIONBiopure MTAD and 1.3% NaClO are effective irrigating agents for removal of the smear layer on the surface of root canal. There is no significant change in the structure of the surface of root canal.

Citric Acid ; Doxycycline ; Edetic Acid ; Humans ; In Vitro Techniques ; Microscopy, Electron, Scanning ; Polysorbates ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy ; Smear Layer ; Tooth Root

Objective To explore the efficacy of non-T cell depletion haploidentical hematopoietic stem-cell transplantation for T lymphoblastic lymphoma (T-LL). Methods 3 T-LL patients achieving complete remission received haploidentical bone marrow stem cell transplantation with granulocyte-colony-stimulating factor (G-CSF) mobilized bone marrow grafts from related donor without T-cell depletion. Two of them received a myeloablative conditioning regimen consisting of high-doses of cyclophosphamide and cytarabine with total body irradiation, whereas the other was preconditioned with busulfan, cyclophosphamide and cytarabine. All patients received strengthened phophylaxis regimen including rabbit anti-thymocyte globulin against acute graft-versus-host disease. Results All patients had rapid hematopoietic engraftment with the median time for neutrophil and platelet recovery being 12 days and 13 days, respectively. They are still alive without relapse at a median follow-up of 24 months (range: 9-75 months). Conclusion Treatment related toxicity can be acceptable in non-T cell depletion haploidenfical hematopoietic stem-cell transplantation for T-LL and the patients may achieve long term survival.

OBJECTIVETo observe the regulatory effect of Bushen recipe (BSR) on immune function in patients with chronic hepatitis B.

METHODSThirty patients with HBeAg+ and abnormal alanine transaminase (ALT) level were treated with BSR for 6 months. The following parameters before treatment, 3 months and 6 months after treatment were tested: (1) HBV DNA by fluorescence quanitiative PCR; (2) Levels of interleukin-10 (IL-10) and interferon-gamma in supernatant of cultured peripheral blood mononuclear cell (PBMC) after had been cultured with HBeAg, HBcAg and phytohemagglutinin (PHA) for 48 hrs; (3) Blood levels of T-cells, including CD4+ , CD8+ , CD8+ CD28+ , CD8+ CD28- and CD28+ , and their ratio, as well as the percentage of CD8+ CD28+ in the cell culture after being co-cultured with PHA for 48 hrs.

RESULTSIn patients effectively treated by BSR, after 3 months treatment, level of IFN-gamma in PBMC culture significantly increased, CD8+ CD28+ , CD28+ T-cells significantly enhanced and IL-10 and CD8 + CD28+ T-cells significantly decreased (P < 0.05, P < 0.01).

CONCLUSIONBSR could significantly strengthen the expression of Th1 type cytokine, decrease the expression of Th2 type cytokine and promote the expression of CD8+ cytotoxic T-lymphocyte, which may be one of mechanisms in suppressing HBV DNA replication.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; isolation & purification ; Hepatitis B, Chronic ; drug therapy ; immunology ; Humans ; Interleukin-10 ; blood ; Male ; Middle Aged ; Phytotherapy ; T-Lymphocyte Subsets ; immunology ; Th1 Cells ; immunology ; Th2 Cells ; immunology ; Virus Replication ; drug effects

Four impurities were isolated from raw material of clindamycin phosphate (CP), and their structures have been determined. LC-MS was used to determine the molecular weights of the impurities in the raw material of CP. Reversed-phase preparative HPLC was used to prepare them, and their chemical structures were identified by HR-MS and NMR. The four unknown impurities were determined as clindamycin-B-phosphate (1), clindamycin-2,4-diphosphate (2), 3',6'-dehydro clindamycin phosphate (3), epi-clindamycin phosphate (4). Impurity 1 has been included in BP and EP, while 2, 3 and 4 have not. The impurities 2, 3, 4 are first separated from raw material of CP.
Anti-Bacterial Agents ; chemistry ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Clindamycin ; analogs & derivatives ; chemistry ; Drug Contamination ; Molecular Structure ; Molecular Weight ; Spectrometry, Mass, Electrospray Ionization

Objective To ohserve the rat myocardial damage induced by citreoviridin(CIT)in the status of combined selenium and protein deficiency.Methods According to 2×2 factorial design,forty 4-week-old healthy Wistar rats were randomly divided into four groups.i.e.combined selenium and protein adequate with no CIT and with some CIT groups(Se+Pro+CIT-.Se+Pro+CiT+),combined selenium and protein deficiency with no CIT and with some CIT groups(Se-Pro-CIT-,Se-Pro-CIT+).The numbers of male and female were fifty-fifty.Theserats were fed with combined selenium and protein adequate and combined selenium and protein deficiency fodder until the 16th week. Cardiac toxicity of CIT was evaluated by general state of health, heart weight index, myocardial pathological change, the levels of selenium and the activities of glutathion peroxidase (GSH-Px) and creatine kinase (CK) in serum, and the activity of superoxide dismutase(SOD) of myocardium. Results The interaction effects of combined selenium and protein deficiency and adequate CIT on body weight, serum levels of selenium and albumin, heart weight index, the activities of CK and GSH-Px in serum and SOD of myocardium were statistically not significant(F= 0.000, 1.210, 0.625, 0.981, 2.785, 0.074, 0.001, all P> 0.05). The main effects of combined selenium and protein on the levels of serum selenium and albumin, heart weight index and the activity of GSH-Px in serum were statistically significant(F = 507.698, 87.734, 4.201, 109.389, all P < 0.05). The main effects of CIT on body weight, the levels of serum selenium and albumin, heart weight index and the activity of CK in serum were statistically significant(F = 10.929, 4.371, 26.108, 24.844, 4.439, all P < 0.05). The mean levels of serum selenium of Se-Pro- groups [(70.4 ± 40.0), (87.7 ± 59.6 )μg/L] were lower than those of Se+Pro+ groups [(446.1 ± 74.8),(502.1 ± 39.2)μg/L, all P < 0.05]. The mean levels of serum albumin of Se-Pro- groups [(34.36 ± 1.28 ), (33.38 ±2.48)g/L] were lower than those of Se+Pro+ groups[(40.69 ± 1.30), (38.71 ± 2.15)g/L, all P < 0.05]. The mean levels of heart weight index of CIT+ groups[(4.14 ± 0.36) × 10-3, (4.39 ± 0.53) x 10-3] were higher than those of CIT-groups[(3.56 ± 0.26) x 10-3, (3.80 ± 0.28) x 10-3, all P < 0.05] respectively at the same levels of selenium and protein. The mean levels of CK in serum of Se-Pro-CIT+ group[(2.54 ± 0.56)kU/L] was lower than that of Se-Pro-CIT- group [(3.37 ± 0.67 )kU/L, P < 0.05]. The mean levels of activity of GSH-Px in serum of Se-Progroups[(408.1 ± 412.6), (510.5 ± 392.0)U/L] were lower than those of Se+Pro+ groups[(1667.8 ± 102.2),(1731.5 ± 144.4)U/L, all P < 0.05]. In Se+Pro+CIT+ group, there was part of intercalary disc of cardiac myocytes fragmented;the conjunctions between myoeytes were broken;in some region, cardiac myocytes became edematous,even dissolved. In Se-Pro-CIT- group, the change of cardiac myocytes membrane structures was not obvious;filament structure was disappeared around nucleus;deposition of mass floccule could be seen. In Se-Pro-CIT+ group,the structure of sarcomeres was not obvious;mitochondrial cristae was loosened;cavities in myocytes could be seen occasionally;there were lots of disseminated sareoplasmic reticulum extending. Conclusions .CIT is the main risk factor in inducing myocardial damage. The deficiency of combined selenium and protein can aggravate the damage,but its independent pathogenic effect is weak.

A case of adrenal ganglioneuroblastoma is presented here. This adrenal ganglioneuroblastoma was found in a 27-year-old female 7 months after delivery. CT clarified that the tumor originated retroperitoneally and was large in size (11.4 cm x 9.4 cm). The tumor was surgically removed together with pancreatic body and tail, left kidney and spleen, and pathological diagnosis was adrenal ganglioneuroblastoma-intermixed. Adrenal ganglioneuroblastoma is extremely rare in adults, with only about 9 cases documented including this case.
Adrenal Glands ; Adult* ; Diagnosis ; Female ; Ganglioneuroblastoma* ; Humans ; Kidney ; Spleen ; Tail