Objective To study the clinical significance of end-tidal carbon dioxide partial pressure (PetCO2 ) during cardiopulmonary resuscitation (CPR) and seek the fixed value according which to decide if we should and when to give up.Methods This was a prospective,observational study.A total of 124 patients with cardiac arrest in or out-of-hospital from may 2003 to March 2009 in emergency department of our hospital were selected.All of them had definite etiological factors.Changes of PetCO2 in 124 cardiac arrest patients during CPR were tracked.Results The gender,age,rescue time in seventy-one patients with the return of spontaneous circulation (ROSC) after endotracheal intubation have a significant difference with that in fifty-three patients without ROSC (P ＜0.01 ).The PetCO2 of the survival were higher than that of patients without ROSC or with ROSC,but finally died (P ＜0.01 ).A fixed point 14.4 mmHg of PetCO2 after 20 minutes' CPR can be used as a reference value to guide CPR or predict prognosis.Conclusions Monitoring PetCO2 during CPR has a predictive value on the success of resuscitation.

Objective To analyze the urodynamic abnormalities of incontinent stroke patients,and evaluate the effects of acupuncture,moxibustion in combination with physical therapy.Methods One hundred and six in- continent stroke patients were divided into a control group and a treatment group.The control group was treated with conventional methods,and the treatment group with acupuncture,moxibustion and physical therapy modalities such as ultrasound and EMG biofeedback.The Urodynamic examination was performed before and after treatment.Re- sults It was found that the uradynamic abnormalities in the incontinent stroke patients include detrusor hyperreflexia and uninhibited sphincter relaxation.Combined use of acupuncture,moxibustion and physical therapy can significant- ly improve the patients' symptoms.Conclusion Common urodynamic abnormalities.are detrusor hyperreflexia and uninhibited external sphincter relaxation in incontinent stroke patients.Combined use of acupuncture,moxibustion and physical therapy is effective for treating this condition.

Over the last decade, chronic critically ill (CCI) has emerged as an epidemic in intensive care unit (ICU) survivors worldwide. Advances in ICU technology and implementation of care bundles has significantly decreased early deaths of critically ill patients, and have allowed them to survive previously lethal multiple organ failure (MOF). However, more and more survivors leave persistent low grade organ dysfunctions, depend on continues organ support, need to stay in ICU, and become CCI patients. These patients experience a persistent immune dysregulation with persistent inflammation, immunosuppression, and catabolic syndrome. Therefore, malnutrition is an important feature of patients with CCI, and nutritional support is a crucial part of their treatment. The main strategies of nutritional support are as follows: providing sufficient calories and proteins with appropriate anabolic agents to promote anabolic metabolism, using immunomodulators to improve immune suppression and inflammatory responses, and supplementing micronutrients to enhance metabolic support. In this review, the nutritional assessment, calorie assessment, protein assessment and other nutrient supplementation (such as β blocker, testosterone and oxandrolone, immunonutrition, vitamins) of CCI patients were reviewed, so as to provide reference for the treatment of CCI.

Objective To determine the effect of age,body figure and risk framing in making treatment decision for female patients with breast cancer.Methods Two groups of healthy female:one group of 60 female ages 18-24 from undergraduate student and the other group of 60 female ages 35-60 from the university community.Healthy women imagined that they had been diagnosed with breast cancer and received information regarding lumpectomy versus mastectomy and recurrence rates.Participants indicated whether they would choose lumpectomy or mastectomy and reasons.Results The different concern levels of body appearance between younger and older women influences treatment selection of lumpectomy versus mastectomy.Facing the risk information,older women were unlikely to select the breast conserving operation.Conclusions The factors of age and the attention to body figure would effect the choice of breast conserving operation or mastectomy.Risk information on the selection of treatment would not affected directly,but the effects of risk information on younger and older female is different.Nurses should provide the age-appropriate information who recently have been diagnosed with breast cancer regarding treatment alternatives to ensure their active participation in the decision-making process,female who have different levels of investment in body figure also may have different concerns about treatment,and should be alert on empathetic of such concerns.

OBJECTIVE:To evaluate the effects of clinical pharmacists participating in disease management of chronic heart failure(CHF). METHODS:A total of 180 CHF inpatients selected from cardiovascular medicine department of our hospital during Jan. 2013 to Dec. 2014 were divided into control group and pharmacist management group according to random number table,with 90 cases in each group. The control group was given routine treatment. The pharmacist management group additionally received indi-vidualized pharmaceutical care,such as pharmaceutical monitoring,psychological counseling,medication education and 6-month follow-up. The comprehensive self-care ability of the 2 groups were compared on admission and on discharge;re-hospitalization and mortality were compared between 2 groups within 6 months after discharged;the patients’NYHA classification,LVEF,plas-ma level of NT-proBNP and quality of life were compared between 2 groups on admission and 6 months after discharge. RE-SULTS:There was no statistical significance in the cognition of patients to disease,self-care ability,medication compliance score and total comprehensive self-care ability score between 2 groups on admission (P>0.05). Each score and total score of 2 groups were better on discharge than on admission,and the pharmacist management group was better than control group,with statistical significance(P<0.05). Within 6 months after discharge,re-hospitalization rate of pharmacist management group was significantly lower than that of control group,with statistical significance (P<0.05). There was no statistical significance in mortality rate be-tween 2 groups (P>0.05). There was no statistical significance in NYHA classification,LVEF,plasma level of NT-proBNP be-tween 2 groups on admission(P>0.05). 6 months after discharge,the above 3 indexes of pharmacist management group as well as NYHA classification and plasma level of NT-proBNP of control group were improved significantly compared to on admission;NYHA classification,LVEF and plasma level of NT-proBNP of pharmacist management group were better than those of control group at corresponding period,with statistical significance (P<0.05). There was no statistical significance in social limit,mood, symptom score and total score of life quality between 2 groups on admission(P>0.05). 6 months after discharge,each score and total score of 2 groups were all better than on admission,and the pharmacist management group was better than control group, with statistical significance (P<0.05). CONCLUSIONS:The participation of clinical pharmacists in the disease management of CHF can significantly improve comprehensive self-care ability,decrease re-hospitalization rate,ameliorate cardiac function and en-hance the quality of life.

Objective To study the influence of combined spinal-epidural anesthesia on perioperative coagulation function,RAAS activity and postoperative analgesia effect in parturients with cesarean section.Methods One hundred and eighteen parturients of cesarean section in our hospital from June 2013 to January 2016 were collected and divided into the observation group and control group according to the random number table method,59 cases in each group.The observation group received the combined spinal-epidural anesthesia and the control group received epidural anesthesia.The coagulation function indicators on preoperative 1 d (T0),at 10 min before operation end(T1) and postoperative 6 h (T2) were detected by adopting the automatic blood coagulation analyzer,the renin angiotensin aldosterone system (RAAS) function indices were detectd by radioimmunoassay.The pain indicators at postoperative 6 h(T2),12 h (T3) were detected by the pain threshold test instrument.Results The levels of prothrombin time(PT),activated partial thromboplastin time (APTT) and thrombin time (TT) at T1 and T2 in the observation group were significantly higher than those in the control group,while the PTA level was lower than that in the control group(P<0.05);serum RAAS indices such as (renin),angiotensin Ⅱ(ANG II) aldosterone(ALD) in the observation group were lower than those in the control group(P<0.05).The VAS score at T2,T3 in the observation group was lower than that in the control group,while the pain threshold and pain tolerance threshold levels in the observation group were higher than those in the control group(P<0.05).Conclusion Combined spinal-epidural anesthesia can reduce the blood coagulation and RAAS activation caused by cesarean section trauma,and the effect of postoperative analgesia is more significant.

Objective To compare the EC50 of Propofol for inhibiting intubation response. Methods 80 cases un-derwent tracheal intubation general anesthesia, all patients were randomly divided into two groups. The general situ-ation between the two groups showed no significant difference. Except for Propofol, other anesthesia drugs infusion method and dosage were the same. Sequential determination the EC50 of Propofol which for inhibiting intubation re-sponse of each groups by up-and-down. Propofol target concentration of the first patient was set to 4 μg/ml, and ad-justed according to intubation stress response disappeared or not, concentration of two adjacent patients with ratio of 1.2. Results A group inhibited the cardiovascular responses of Propofol EC50 and 95%CI was 5.19 μg/ml (95%CI:4.88 ~ 5.50 μg/ml). B group inhibited the cardiovascular responses of Propofol EC50 and 95 %CI was 4.15μg/ml (95%CI:3.80~4.40μg/ml). The EC50 and 95% confidence interval of the B group were significantly lower than those of the A group ( P< 0.05). The MAP and HR at T2 were higher than that of T1 in each group ( P< 0.05), and the MAP and HR of observe group were lower than that of control group ( P< 0.05). The MAP and HR at T3 were lower than that of T1 in control group ( P< 0.05), but there were no significant deference in observe group ( P> 0.05).Conclusion The EC50 and 95% confidence interval of Propofol for inhibiting intubation response under photopic laryngoscopes was significant lower than those of under direct laryngoscopes, the circulation during period of induc-tion and intubation was more stable.

Matrix metalloproteinase-2 (MMP-2) level and the ERK1/2 signal pathway are dependent factors for the growth and metastasis of cancer. However, the impact of MMP-2 in combination with ERK1/2 in tumor patients with drug resistance is unknown. To determine the relationship between MMP-2 and the ERK1/2 signal pathway, we established an adriamycin (ADM)-induced MG-63 (ADM-MG-63) cell line. With the increase of the ERK1/2 pathway blocker PD98059, we detected the expression levels of MMP-2 and p-ERK1/2 by Western blot in ADM-MG-63 cells. In ADM-MG-63 cells transfected with MMP-2-siRNA, the expression of ERK1/2 was detected for understanding the function of the ERK1/2 signal pathway. Three siRNAs for MMP-2 (MMP-2-siRNA) were designed, and the optimal one was selected and tested at different time points of 24, 48 and 72 h. Under an ADM-induced condition, ADM-MG-63 cells were finally stable living in the medium of ADM (200 ng/mL). PD98059 could effectively suppress the expression levels of p-ERK1/2 and MMP-2. When the MMP-2 was silenced by using MMP-2-siRNA, the expression of p-ERK1/2 was enhanced. It is concluded that MMP-2 may be involved in ADM resistance dependent on ERK1/2 signal pathway, suggesting interference in ERK1/2 may be a new method of targeted therapy for tumor resistance.

Objective To evaluate a new type of endoloop for closure of full-thickness gastric defects left by EFR.Methods A total of 32 patients who underwent EFR at our hospital between October 2014 and February 2015 with gastric fundus submucosal tumors were retrospectively analyzed.After the resection,LeCampTM endoloops and Olympus endoloops were used respectively to close the gastric defect in the study group (n =14) and the control group(n =18).The closure success rates,closure time,complications and the healing rates were compared.Results All lesions were removed by using EFR technique.The closure success rates of the two groups were both 100％.The closure time were 13.86 ± 4.62 minutes and 18.28 ± 6.48 minutes in study group and control group respectively with significant difference (P ＜ 0.05).9.43 ±4.09 metallic clips and 1.00 ±0.00 endoloops were used in study group and 9.67 ± 3.61 metallic clips and 1.06 ± 0.24 endoloops were used in control group (P ＞ 0.05).One patient in study group and 2 patients in control group received abdominal puncture for relieving the pneumoperitoneum during the operation (P ＞ 0.05).No complications such as subcutaneous emphysema,pneumothorax,pneumomediastinum,delayed bleeding,or abdominal infection were found after the operations in either group.The wounds healed in all patients in 2 months after the procedure.Conclusion The use of novel endoloop and metallic clips is a relatively safe,easy,and feasible method for repairing large gastric post-EFR defects,which is of good clinical application value.

elayed contrast enhanced MRI showed significant different pooled sensitivity in comparison to low-dese dobutamine stress echocardiography.