Objective To evaluate the effect of dexmedetomidine on p38 mitogen -activated protein kinase (p38MAPK)signaling pathways in ventilator -induced lung injury of rats.Methods 100 SD rats were divided into 5 groups(n =20)by random number table.The control group(Group C),mechanical ventilation(Group H)and different dosage of dexmedetomidine group (Group DEX1 -3 ).Group C:no mechanical ventilation with natural breathing air for 4h;Group H:high tidal volume ventilation for 4H,inhaled oxygen concentration was 21%;Group DEX1 -3:20min before mechanical ventilation,infusion of dexmedetomidine(0.5,1.0,and 2.0μg/kg)with loading dose (5mL,0.5,1.0,and 2.0μg·kg -1 ·h -1 )for 4 hours.Femoral arterial blood were collected after mechanical ventilation for 1h,2h and 4h(T1 -4 )in basic status,the arterial blood gas and the PaO2 were analysized and recorded. concentration of total protein,TNF -αand macrophage inflammatory protein -2(MIP -2)in bronchoalveolarlavage fluid(BALF)were detected in rats after ventilation for 4h;myeloperoxidase(MPO)activity in lung tissue was deter-mined;intercellular adhesion molecule -1(ICAM-1)expression and lung wet/dry weight(w/d)ratio were detected;p -p38MAPK protein expression was detected by Western blot;pathological changes of lung tissue in each group and cell apoptosis were observated.Results Compared with the group C,expression of P -p38MAPK(5.4 ±0.5)and p38MAPK/p -p38MAPK(1.64 ±0.17)increased in Group H(F =3.22,3.28,all P <0.05),accompanied by the increased expression of CAM-1 in lung tissue,MPO activity,total protein,TNF -αand MIP -2 concentration in the BALF[(6.4 ±1.1),(1.95 ±0.16)U /g,(1 459.39 ±0.29)mg/L,(182 ±9)ng/L,(436 ±31)ng/L](F =3.53, 3.66,3.21,3.32,3.43,all P <0.05);.And compared with group H,expression of p -p38MAPK and p38MAPK/p -p38MAPK in DEX2 groups and DEX3 fell(F =3.22,3.28,all P <0.05)accompanied by decreased expression of CAM-1 in lung tissue,MPO activity,total protein,TNF -a and MIP -2 concentration in the BALF(F =3.53,3.66, 3.21,3.32,3.43,all P <0.05).Compared with the group H,PaO2 at each point showed no statistically significant difference in group DEX1 -3(F =1.43,P >0.05),and no significant difference of W/D in group DEX 2 ~3(F =2.89,P >0.05 ).Heavy pathological damage of lung tissue and significant apoptosis were observed in group H. Conclusion Dexmedetomidine can inhibit the development of ventilator -associated lung injury.The mechanism may associated with the inhibition of phosphorylation of p38MAPK,thereby inhibiting the expression of downstream inflam-matory factors.

In 2016, American Association of Clinical Endocrinologists(AACE) published the guidelines for obesity and defined obesity as an adiposity-based chronic disease and obesity should be managed according to the obesity-related complications (16 complications are listed). Obesity intervention should be transferred from the purpose of weight loss to the intervention of metabolic disorder and its complications. The diagnosis and intervention of obesity in this guideline is sub- classified focus on the gender, region, and combined diseases, which is with more practical and scientific significances. This interpretation is expected to help the professional medical staffs to understand the new strategy in obesity therapy and to combine with the real world and clinical experience. New suggestions should put forward and improve the theories.

BACKGROUND:There are many studies on the establishment of animal models of femoral head necrosis, but it is difficult to simulate an ideal animal model of femoral head necrosis, especialy colapse models. OBJECTIVE: To establish femoral head necrosis model of double-foot large bird emu so as to simulate femoral head necrosis in human. METHODS: A total of 30 adult emus were frozen in liquid nitrogen and received radiofrequency heating alternately to simulate femoral head necrosis models. After 3 cycles of freezing, local frozen in liquid nitrogen and method of radiofrequency heating was alternated for closed loop liquid nitrogen freezing injury and radiofrequency heating injury. At 6, 12 and 16 weeks after model establishment, gross observation, X-ray, histology examination and MRI were conducted. Effects of model induction of avascular necrosis of the femoral head were evaluated. RESULTS AND CONCLUSION: After liquid nitrogen cold-hot alternating method, emu at 12-18 weeks gradualy suffered from femoral head necrosis signs and imaging findings. X-ray films, histological examination and MRI examination showed the avascular necrosis of femoral head was consistent with the pathological process of human femoral head necrosis, and the model had good repeatability. These results indicate that the use of liquid nitrogen cold-hot alternating method has successfuly established the model of femoral head necrosis, with a goodcolapse rate, and can be used for mechanism research and treatment evaluation of osteonecrosis.

Objective To detect and analysis on serum infectious indicators in patients before receiving blood transfusion .Meth‐ods 5 790 patients admitted to the hospital from June 2012 to April 2015 to be treated with blood transfusion were enrolled in the study and underwent detections of various infectious indicators ,including Hepatitis B surface antigen(HBsAg) ,anti hepatitis C vi‐rus antibody(anti‐HCV) ,anti human immunodeficiency virus antibody (anti‐HIV) and anti syphilis helicoid antibody (anti‐TP) . The positive rate of infectious indicators in 5 790 cases of blood transfusion before transfusion ,the positive rate of infectious indica‐tors in different departments and the positive rate of infectious indicators in patients of different gender were calculated .Results The positive rate of HBsAg was the highest ,which was 18 .2% .The positive rate of anti‐HIV was the lowest ,which was only 0 .26% .In obstetrics and gynecology department ,the positive rate of HBsAg and anti‐HIV were the highest ,and the positive rate of anti‐HCV and anti‐TP were basically the same in each department .The positive rate of HBsAg ,anti‐HCV ,anti‐HIV and anti‐TP in male blood recipients before transfusion were higher than that of female ,the difference was statistically significant(P<0 .05) . Conclusion It is very necessary to detect the serum infectious indicators in blood recipients before blood transfusion ,which can ef‐fectively block the spread of infectious diseases such as hepatitis ,AIDS ,syphilis and so on and protect blood recipients and medical workers .

In total knee arthroplasty, perioperative analgesia is transforming into multimodal analgesia.As a significantly important part of fast track surgery ( FTS ) protocol, perioperative analgesia does affect the recovery of patients.We reviewed the advantages and disadvantages of perioperative ( pre-operative, intra-operative and post-operative ) analgesia in FTS protocols in total knee arthroplasty, including the latest progress of the field.

Objective To investigate the effect of Bushen Digui Decoction in treatment of chronic nephritis proteinuria of spleen kidney qi deficiency.Methods 100 patients with chronic nephritis of spleen kidney qi deficiency were randomly divided into two groups,and each group had 50 cases.The control group was given lotensin,while the study group was given Bushen Digui Decoction.The relationship between proteinuria,kidney function improving and TCM clinical signs in the two groups were observed.Results The effective rate of study group was 76.0％,which was significantly higher than that of the control group 62.0％ (P ＜ 0.05).The effective rate of the study group according to the TCM criteria was 82.0％,which was significantly higher than that of the control group 52.0％ (P ＜0.01).24h urinary protein in the control group before treatment was (1.89 ±0.87) g,after treatment for six months was (1.45 ±0.63)g,those of the study group was (1.90 ±0.86)g,(1.01 ±0.58)g.24h urine protein in beth two groups after treatment was decreased,and the difference was statistically significant (P ＜ 0.05).After treatment,the low back pain,shortness of breath,fatigue,edema,loose stools diarrhea,frequent urination,or nocturia range of TCM symptom score improvement of the study group were significantly better than control group (P ＜ 0.05),while TCM main symptoms before and after treatment showed no improvement in the control group.Before and after the treatment,the study group and the control group in the total protein content,kidney function markers (SCr,BUN,Alb and CCr content) had no significant differences (P ＞ 0.05).Conclusion Bushen Digui Decoction can significantly improve patients' kidney function and reduce proteinuria remission in patients with low back pain,shortness of breath,fatigue,swelling,loose stools diarrhea,frequent urination,or nocturia many other symptoms.

Objective To investigate the effect of general anesthesia of laryngeal mask airway in laparoscopic appendectomy;Methods 106 cases of laparoscopic appendectomy patients in the informed consent were randomly divided into LMA group and intubation group by odd and even numbers of hospital,53 cases per group,all patients were used of rapid induction of general anesthesia,oxygen 3 ～ 5min,laryngeal mask insertion laryngeal mask anesthesia,intubation group received tracheal intubation under general anesthesia,then compared of both groups in vital signs and complications; Results HR and MAP of intubation group 5min after intubation was statistically significant from during anesthesia and anesthesia stopped 5 min ( t = 7. 823,6. 849,15. 331,17. 636, all P ＜ 0. 05 ), MAP and HR of other point had no significant difference ( P ＞ 0. 05 ). Regurgitation and aspiration, and complications such as nausea and vomiting had not been observed,emergence agitation in the LMA group was 5.7% ,cough was 9. 4% ,hoarseness was 1.9% all were significantly lower than the intubation group( x2 = 10. 415,7. 996,5. 410, all P ＜ 0. 05 ). Conclusion Laryngeal mask airway under general anesthesia with intubation in the laparoscopic appendectomy had the same anesthetic effect and it's impact on vital signs were small ,and it had a lower incidence of complications.

Lysosomal storage disorders (LSDs) are genetic defects caused by lysosomal hydrolase deficiencies. These deficiencies lead to substrate accumulation affecting cells, tissues and organs. Detecting abnormal compound excretion and deficient enzymes assist diagnosis of these disorders for treatment and prevention. This mini review summarizes clinical presentations and diagnostic workup of LSDs and updates the new development in the area.

Objective To summarize and analyze related examinations of chronic hepatitis B so as to find out the best detection method,which could also improve the diagnostic accuracy rate of chronic hepatitis B.Methods The clinical material of 238 patients with chronic hepatitis B (liver disease group) from March 2012 to November 2013 were studied by using the regression analysis,and meanwhile 238 cases of normal healthy people were selected as control group,the two groups' blood routine,routine biochemical indicators and new biochemical indexes were carefully studied and analyzed,and the positive rates and accuracy of using the biochemical indexes to diagnose chronic hepatitis B were also studied.Results The leukocyte count,neutrophil count and platelet count in liver disease group were respectively (5.10 ± 1.79) ×109/L,0.558 4 ± 0.123 2 and(101.38 ± 79.55) × 109/L,which were all significant lower than those in control group[(6.83 ± 1.45) × 109/L,0.617 8 ± 0.090 1 and (172.29 ± 43.22) × 109/L (P＜ 0.05),and lymph cells were 0.367 7 ± 0.121 0 which were significantly more than that in control group (0.303 9 ± 0.064 5) (P ＜ 0.05).The total bilimbin and alanine aminotransferase in liver disease group were (22.47 ± 7.28)μ mol/Land (97.01 ± 14.18) U/L which were significantly higher than those in control group (15.88 ± 5.19) μ mol/Land (29.87 ± 9.16) U/L (P＜ 0.05),while the albumin,albumin and globubin ratio were significantly lower than that in control group [(38.28 ± 5.77) g/L vs.(45.23 ± 2.34) g/L,1.32 ± 0.21 vs.1.59 ± 0.23] (P ＜0.05) ; adenosine deaminase,5'-nudeotidase,total bile acid,leucine aminopeptidase in liver disease group were significantly higher than that in control group [(24.30 ± 13.12) U/L vs.(9.21 ±2.72) U/L,(12.82 ±12.21) U/L vs.(5.22 ±2.39)U/L,(61.28 ±30.09) mol/L vs.(5.70 ±2.78) mol/L,(64.80 ± 19.21) U/L vs.(41.23 ± 11.32) U/L] (P ＜ 0.05),while transferrin and prealbumin (PA) were significantly lower than that in control group [(17.43 ±8.23) μmol/L vs.(32.44 ±6.90) μmol/L,(123.28 ± 22.31) mg/L vs.(324.20 ± 34.88) mg/L] (P ＜ 0.05); PA and ADA's positive rates were 91.7％and 82.3％ respectively,and the areas under the curve of the two groups were 0.92 and 0.95 respectively.Conclusions It is probably of great help and reference for doctors to accurately assess the liver functions,diagnose and treat chronic hepatitis B patients that using blood routine examinations and the conventional biochemical indexes.

Acute hepatic failure (AHF) is a severe liver disease associated with a variety of clinical symptoms . AHF is difficult to treat and with a high mortality rate.Therefore, it is necessary to establish animal models of AHF for the investigation of therapy.In this article, the preparation methods of AHF animal models are reviewed which are applicable to different types of animals.