ve Cardiac output is traditional measured by thermodilution technique. Recent advance in catheter technique has allowed continuous monitoring of cardiac output, but it is invasive and expensive. The new transesophageal Doppler echocardiography (HemosonicTM 100) can measure aortic blood flow (ABF) and ABF is closely related to cardiac output (CO) (CO= ABF/70%). The purpose of this study was to compare cardiac output continuously measured with transesophageal Doppler echocardiography and modified Swan-Ganz catheter. Methods Forty ASA II - III patients aged 40-65 yr undergoing elective coronary artery bypass (CAB) were included in this study. Premedication consisted of intramuscular diazepam 10 mg, morphine 10 mg and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.08 mg?kg-1, fentanyl 10?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation, continuous infusion of propofol and intermittent boluses of fentanyl, midazolam and pipecuronium. The sensor of transesophageal Doppler echocardiograph (TDEE) was placed in the esophagus at the level of T5-6 vertebra after induction and tracheal intubation. The sensor faced backward toward descending aorta. Swan-Ganz catheter (CCO/Sv()2) was placed via right internal jugular vein. In addition intra-arterial BP, ECG, SpO2, PET CO2 and nasal temperature were monitored.Results Continuous cardiac output measured with TDEE and Swan-Ganz catheter (CCO/SvO2) were highly correlated (R = 0.801, P

Authors described the patterns,core measures and mechanisms of coordinated care delivery in the localities and analyzed initial outcomes of this practice.It is found that such practice has optimized distribution of regional healthcare resources,implemented first visit to primary institutions, and the care delivery to separate emergency from outpatient service.In addition,the paper analyzed problems found in localities in terms of policy,public hospitals and primary institutions,and proposed elements required for coordinated care delivery system to succeed,such as enhanced policy support, enhanced multi-departmental coordination,and public hospital reform to explore feasible approaches.

Objective To investigate the effects of warming-needle acupuncture on the levels of matrix metalloproteinase-1 (MMP-1) and interleukin-1β (IL-1β) in the articular cartilage in knee osteoarthritis induced by immobilization in rabbits.MethodsA total of 30 adult male Japanese white rabbits were randomly assigned into three groups by random number table method: a normal group, a model group and a treatment group, with 10 rabbits in each group. Knee osteoarthritis was induced by 6 weeks of immobilization. The rabbits in the treatment group received warming-needle acupuncture after modeling at points of “Neixiyan” (EX-LE4), “Dubi” (ST35), “Zusanli” (ST36) and “Yanglingquan” (GB34) for 4 weeks. The level of MMP-1 and IL-1β in the articular cartilage of the knee were determined with radioimmunological assay.ResultsThere were significant difference in the levels of MMP-1(0.16 ± 0.02 ng/mg, 0.37 ± 0.02 ng/mg, and 0.28 ± 0.03 ng/mg;F=258.251) and IL-1β (0.21 ± 0.01 pg/mg, 0.34 ± 0.02pg/mg, and 0.31 ± 0.04 pg/mg;F=127.112) among the normal group, model group and treatment group. The levels of MMP-1 and IL-1β both in the model group and treatment group were significant higher than those in the normal group (allP<0.01), while the levels of MMP-1 and IL-1β in the treatment group were significant lower than those in the model group (allP<0.01).ConclusionWarming-needle acupuncture can effectively reduced the levels of MMP-1 and IL-1β in the articular cartilage in knee osteoarthritis induced by immobilization in rabbits.

OBJECTIVE:To systematically evaluate the effectiveness of probiotics in adjunctive prevention and treatment of chemotherapy-induced diarrhea(CID),and to provide evidence-based reference in the clinic. METHODS:All relevant randomized controlled trials (RCTs) of probiotics in adjunctive prevention and treatment of CID were collected by searching EMBase,Co-chrane library,PubMed,CJFD,VIP,Wanfang databases and CBM. Meta-analysis were performed with Rev Man 5.2 software af-ter data extraction and quality evaluation by Cochrane Hand book 5.0risk-bias assessment tool. RESULTS:10 RCTs were includ-ed,involving 871 patients. The results of Meta-analysis showed that addition of probiotics on the basis of conventional symptomatic therapy significantly reduced the total rate of diarrhea in cancer patients [OR=0.31,95%CI(0.20,0.49),P<0.001] and Ⅲ-Ⅳ diar-rhea rate[OR=0.09,95%CI(0.03,0.24),P<0.001],improved overall response rate [OR=4.16,95%CI(2.40,7.23),P<0.001] and complete remission rate [OR=2.55,95%CI(1.66,3.90),P<0.001],with statistical significance. The probiotics had little effect onⅠ-Ⅱlevel diarrhea rate[OR=0.86,95%CI(0.48,1.56),P=0.62] and partial remission rate[OR=1.00,95%CI(0.67,1.50),P=1.00],with statistical significance. CONCLUSIONS:The use of probiotics before chemotherapy can effectively prevent the occur-rence of severe CID in cancer patients;in the treatment of CID,the combination of probiotics can also improve therapeutic effica-cy of conventional symptomatic treatment.

Objective To investigate the effect of diaphragm training on respiratory function and the activities of daily living after cerebral apoplexy.Methods Seventy-eight patients with post-stroke fatigue were randomly divided into a treatment group and a routine therapy group,each of 39.Both groups were given conventional rehabilitation treatment,while the treatment group was additionally provided with diaphragm muscle training.Before and after 4 weeks of treatment,both groups were evaluated using pulmonary function tests,a fatigue severity scale (FSS),Fugl-Meyer motor function assessment (FMA) and the modified Barthel index (MBI).Results Vital capacity,forced vital capacity,forced vital capacity during the first second,and especially the maximum ventilatory volume of the treatment group were all significantly improved after the treatment.There was also significant improvement in that group's average FSS score,but not in that of the control group.The average FMA and MBI scores for both groups had improved significantly after the intervention,with the average FMA score of the treatment group significantly higher than that of the control group.However,no significant differences in the average MBI score were observed after the treatment.Conclusion Diaphragm training can significantly improve motor function and the daily life of stroke survivors.The mechanism may be related to improved respiratory function and decreased severity of fatigue.

OBJECTIVE:To provide reference for medical costs control in China. METHODS:Based on main characteristics of the United States health service system,information asymmetry,principal-agent theory and Freedman’s consumption theory were used to analyze the advantages of restrictive relationship among doctors,hospitals and health insurance institutions in control-ling medical costs and improving the quality of diagnosis and treatment. The growth rate of medical cost,the percentage of drug ex-penditure and other aspects were compared between China and the United States;the effect of restrictive relationship on medical cost control was demonstrated. RESULTS & CONCLUSIONS:In the United States,there are hierarchical medical system and two-way referral system;for-profit hospitals and non-profit hospitals are mutually complementary;different natures of health insur-ance system,different payment methods and strict“commercial bribe”monitoring system are carried out;doctors,hospitals and health insurance restrict each other. Not only there are many advantages in theory,but also in practice the growth rate of medical cost and the percentage of drug expenditure are superior to our country. Finally it controls the rapid growth of medical cost to a cer-tain extent. Combined with our national conditions,learning from the United States experience,restrictive relationship among doc-tors,hospitals and health insurance institutions is established to control the increase of medical cost in China through reducing infor-mation asymmetry and standardizing payment audit;establishing a scientific pattern of mixed payment;strengthening the indirect impact of the health insurance institutions on doctors and hospitals,etc.

BACKGROUND:Bone tissue transplantation or osteogenic material fil ing is after used for bone defect repair. To remove autologous bone tissues can lead to additional damage and secondary deformity, therefore, it is extremely urgent to search for a new osteogenic material. OBJECTIVE:To construct the porousβ-tricalcium phosphate (β-TCP)/col agen scaffold modified with human bone morphogenetic protein 2 (hBMP2) gene, and to observe its effects on differentiation of MC3T3-E1 cel lines. METHODS:The porousβ-TCP/col agen scaffold modified with hBMP2 gene was prepared. Then in vitro culture system of MC3T3-E1 cel lines with composite scaffold was established. There were scaffold and plate groups, and each group was divided into two subgroups according to the different concentrations of plasmid. Samples were col ected and observed morphological y by scanning electron microscope and light microscope after complex culture. After 1, 3, 7 and 14 days of induction, calcium nodules were observed through alizarin red staining, the cel cycle was detected by real-time PCR, and expressions ofαI-chain col agen type I gene, Osterix and bone sialoprotein were observed. RESULTS AND CONCLUSION:The number of cel s adhered, differentated and distributed on the composite scaffold was significantly higher than that of the single scaffold (P<0.05). Alizarin red staining and real-time PCR detection showed that the osteogenesis ability of MC3T3-E1 cel lines in the scaffold group was stronger than that in the plate group. To conclude, the porousβ-TCP/col agen scaffold modified with hBMP2 gene is an appropriate candidate for bone defect repair.

Objective To study the expression of multidrug resistance associated protein 1 (MRP1) and MRP2 in the peripheral blood mononuclear cells of children with intractable epilepsy (IE).Methods During Nov.2010 to Oct.2013,50 children with I E were collected as the experimental group,simultaneously 50 children with epilepsy controlled by the anti-epileptic drugs (AEDs) and 50 healthy children without epilepsy were collected as the control group from the outpatient or inpatient of Xuzhou Children's Hospital.The expressions of MRP1 and MRP2 in the peripheral blood mononuclear cells of children were detected by reverse transcriptase polymerase chain reaction and Western blot.Results 1.The mean relative expression of MRP1 and MRP2 mRNA in the peripheral blood mononuclear cells of children with IE (0.795 ± 0.042,0.804 ± 0.023) were higher than those in epilepsy controlled by AEDs (0.682 ± 0.030,0.675 ± 0.021) and healthy children without epilepsy (0.665 ± 0.031,0.654 ± 0.029) (all P ＜0.001).2.The mean relative expression of MRP1 and MRP2 protein in the peripheral blood mononuclear cells of children with IE (2.027 ±0.034,1.902 ±0.021) were higher than those in epilepsy controlled by AEDs(1.131 ±0.042,1.086 ± 0.027) and healthy children without epilepsy (1.093 ± 0.023,1.045 ± 0.018) (all P ＜ 0.001).3.There was no difference in the expression of MRP1,MRP2 mRNA and proteins between the children with epilepsy controlled by AEDs and healthy children without epilepsy (all P ＞ 0.05).Conclusions MRP1 and MRP2 over-expression in the peripheral blood mononuclear cells of children with IE may be associated with drug-resistance mechanism for medically intractable epilepsy.

Objective Clinical parenteral nutrition( PN) support still lacks in standards on some degree .This paper was to analyze the clinical application of PN support in our hospital in order to provide the basis for clinical rational drug use . Methods Random weighting method was applied to collect 5% hospitalized patients′information from each patient unit each month from April 2012 to March 2013 in Nanjing Gerneral Hospital of Nanjing Military Region .NRS-2002 nutrition risk screening was applied to eval-uate whether the patient needed PN support .Statistical analysis were carried out on patients supported with parenteral nutrition from department distribution, PN detailed components and distribution intervals of aII in one admixture non-protein calorie and nitrogen ra-tio. Results According to the survey, 393 patients had received PN support, including 217 cases′NRS score <3 and 176 cases′NRS score ≥3.General surgery department ranked the first in the cases of usingall in oneadmixture support.Among 133 cases receiving all in one admixture support, the course of 37 cases(27.82%) <7 d.The aII in one admixture non-protein calorie and ni-trogen ratio(100~150∶1) only took up 28.57%. Conclusion Although PN has got wide application in clinical departments, the rationality of prescription should be strengthened .Pharmacists should help doctors set up appropriate prescription from the aspect of pharmacy.

OBJECTIVE: To observe the changes of endothelium-dependent dilation (EDD) of patients with congestive heart failure (CHF) before and after Kanli Decoction treatment. METHODS: Thirty-five CHF patients were treated with Kanli Decoction. We used color Doppler ultrasound to monitor the flow-mediated dilation (FMD), pulsatile index (PI), resistance index (RI), baseline blood flow (BF), ejection fraction (EF) before and after the treatment. RESULTS: FMD after treatment (9.26+/-3.19) were obviously higher than that before the treatment (7.06+/-2.58) (P<0.05), but BF, PI and RI were not improved. CONCLUSION: Applying color Doppler ultrasound into observation on EDD of patients suffering from CHF and treated by the Kanli Decoction shows that the CHF could be treated by traditional Chinese medicine.