Child ; Evidence-Based Medicine ; Humans ; Kidney Diseases ; therapy

Objective To investigate the feasibility of different doses of dexmedetomidine required to prevent sufentanil-induced cough during anesthesia induction. Methods Two hundred and forty ASA Ⅰ or Ⅱ patients, aged 18-55 yr, weighing 45-78 kg, undergoing elective gynecological operations under general anaesthesia, were randomly divided into 4 groups ( n = 60 each) : Ⅰ -Ⅳ groups. Ⅱ -Ⅳ groups received iv infusion of dexmedetomidine 0.10, 0.25 and 0.50 fig/kg at a rate of 0.05 μg·kg-1·min-1 respectively before anesthesia induction. Anesthesia was induced with target-controlled infusion of propofol (target effect-site concentration 5 μg/ml) , when the BIS value reached 55, iv sufentanil 0.5 fig/kg was injected over 3 s. The occurrence and degree of cough were recorded within 1 min after sufentanil injection. Tracheal intubation was facilitated with succinylcholine 1-2 mg/kg after the observation. The adverse cardiovascular events (severe sinus bradycardia, hypotension) were also record ed from the start of dexmedetomidine infusion to 1 min after intubation. Results The incidences of cough were 25 % , 7 % , 7 % and 5 % , incidences of severe sinus bradycardia 0, 3 % , 15 % and 25 % , and incidences of hypotension 5% , 7% , 8% and 8% in Ⅰ - Ⅳ groups respectively. Compared with group Ⅰ , the incidences of cough were significantly decreased in Ⅱ - Ⅳ groups, while the incidences of severe sinus bradycardia increased in Ⅲ -Ⅳ groups (P ＜ 0.01) . There was no significant difference in the incidences of cough among Ⅱ - Ⅲ groups and in the degree of cough among the four groups (P ＞ 0.05). Conclusion Intravenous dexmedetomidine 0.10 μg/kg can be used to prevent sufentanil-induced cough during anesthesia induction.

Objective To probe into the present deployment of human resources at TCM hospitals,for the purpose of enabling the TCM hospital administrators in their policy making and nmagement of human resources.Methods 39 hospitals in the province were subject to a descriptive stndy. Results Nursing human resources in TCM hospitals in the province were found to be in shortage in general;other characteristics include irrational structure of their academic titles,insufficient nurses with senior academic titles,yet an improving proportion of competent nurses;lack of a unified model for TCM nursing in-service education confines the growth of TCM nursing personnel and TCM nursing academic development.Cbnclusion Health authorities and hospitals should deploy nurses per nursing workload,scientifically manage the contractual nurses,optimize the makeup of nursing personnel,launch fundamental training in TCM nursing,for the purposes of higher HR efficiency and better inheritance and development of TCM nursing studies.

Objective To analyze the complications during and after the surgical treatment for long bone fractures in children with titanic elastic intramedullary nail(TEN),in order to improve the technique and potential shortcomings in these surgeries,and reduce the incidence of complications.Methods A retrospective study was done on the 182 children with long bone fractures treated with TEN from Jan.2005 to Jan.2008.A summary and analysis was made on the complications of these cases.Results All the 182 cases had the bones healed.During the operation,split in bone cortex was found in 3 cases,penetration into epiphysis by nails was found in 1 case.After operations,irritated skin and exposed nail was found in 3 cases,prolonged bone healing in 2 cases,limitation of range of motion in the knee in 1 case,bent nail in 1 case,difficulty in retracting the nail in 10 cases,shortening in 2 cases,second fracture of the healed long bone in 1 case.The results were excellent in 173 cases,good in 6 and fair in 3,and the rate of excellent and good was 98 %.Conclusions Though it has certain complications,the technique of TEN in the treatment of children's long bone fractures has more advantages over other internal fixations.Carefully performing the procedure according to the principal of TEN can decease and prevent most of these complications.

Objective To observe the effects of low molecular weight heparin (LMWH) combined with dexamethasone (Dex) on coagulation and fibrinolysis at the early stage in rats with acute respiratory distress syndrome (ARDS) induced by two-hit of oleic acid (OA) and lipopolysaccharide (LPS).Methods Forty healthy adult male Sprague-Dawley (SD) rats were randomly divided into sham operation, ARDS model, Dex, LMWH and combining therapy groups (8 rats in each group). The rat ARDS model was established by sequential two-hit with intravenous injection of OA 0.2 mL/kg in a tail vein and intra-peritoneal injection of LPS 5 mg/kg. After model establishment, the rats in Dex group were intra-peritoneally injected with 10 mg/kg Dex, and those in LMWH group were intravenously injected with 200 U/kg LMWH, while the rats in combining therapy group were given Dex and LMWH simultaneously with the same dosages and methods as above mentioned respectively. In sham operation group, however, the rats were intravenously injected with 0.4 mL of normal saline (NS) and were given 2 mL/kg of intra-peritoneal NS injection, and they accepted another 1 mL/kg NS intra-peritoneal injection 4 hours later, the other procedures being the same as those in the model group. The experiment was ended at 6 hours after the establishment of ARDS model. A light microscope was used to observe the pathological changes in lung tissues, partial pressure of arterial blood oxygen (PaO2) was measured, and the oxygenation index (PaO2/FiO2) was calculated. Wet to dry weight (W/D) ratio of lung tissues was also checked. Coagulation indexes were measured by solidification method, and the serum level of plasminogen activator inhibitor-1 (PAI-1) as well as the content of procollagen type Ⅲ (PC-Ⅲ) was determined by enzyme linked immunosorbent assay (ELISA).Results Under the light microscope, effusion of red blood cells, fibrin deposit in the lung interstitium and alveoli, formation of transparent membrane at alveolar wall, inflammatory cells infiltration in pulmonary interstitial tissue, and fibrinous thrombi in lung capillaries or lung arterioles were seen in the model group. Compared with model group, the red blood cells effusion and fibrin deposition in the lung interstitium and alveoli were less, inflammatory cells infiltration in pulmonary interstitium was alleviated and the fibrinous blood emboli in the lung capillaries or lung small arterioles were also decreased in Dex, LMWH and combining therapy groups, among the three groups, the best results being in the combining therapy group. Compared with sham operation group, the PaO2/FiO2 was significantly lowered [mmHg (1 mmHg = 0.133 kPa): 272.02±28.28 vs. 420.24±35.52,P < 0.01], the lung W/D ratio was obviously higher (5.59±0.40 vs. 3.82±0.28,P < 0.01), prothrombin time (PT) as well as thrombin time (TT) were markedly longer [PT (s): 18.78±1.57 vs. 16.36±0.97, TT (s): 39.02±5.03 vs. 29.22±8.83, bothP < 0.05], fibrinogen (Fib) content was significantly decreased (g/L: 1.82±0.26 vs. 2.69±0.40,P < 0.01), but both the serum contents of PAI-1 and PC-Ⅲ were remarkably elevated in model rats [PAI-1 (ng/L): 719.04±103.74 vs. 517.25±119.18, PC-Ⅲ (μg/L): 29.93±3.24 vs. 22.97±6.26, bothP < 0.01); Compared with model group, the level of PaO2/FiO2 was significantly elevated, and the lung W/D ratio was obviously decreased in Dex, LMWH and combining therapy groups respectively, the most significant changes being in combining therapy group [PaO2/FiO2 (mmHg): 376.78±25.25 vs. 272.02±28.28, lung W/D ratio: 4.14±0.42 vs. 5.59±0.4, bothP < 0.01] , in LMWH group, the prolongation of TT was the longest (s: 52.00±4.24 vs. 39.02±5.03,P < 0.05), while Fib contents in the three treatment groups were all obviously increased (g/L: 2.37±0.38, 2.59±0.51, 2.59±0.24 vs. 1.82±0.26,P < 0.05 orP < 0.01); meanwhile, the decrease of PAI-1 in combining therapy group was the greatest (ng/L: 546.02±93.94 vs. 719.04±103.74,P < 0.01). The indexes showed no statistically significant differences among the three treatment groups, except that PT in combining therapy group which was significantly longer than that in Dex and LMWH groups (s: 19.98±1.61 vs. 17.20±1.48, 17.02±2.34, bothP < 0.05). Conclusions The rats with ARDS induced by two-hit of OA combined with LPS have coagulation dysfunction and fibrinolytic inhibition. Using LMWH early can improve coagulation and fibrinolytic status in the rats with ARDS, and the therapeutic effects of LMWH plus Dex for treatment of ARDS are better than those of using each of them alone.

IgA nephropathy is a complex disease with unclear mechanism,microRNAs may involve in the disease,and some of them may be associated with the key enzyme of IgA nephropathy-core β1 3-galactosyl-transferase.The concept of epigenetics and the structures and functions of microRNA were introduced.Through reviewing the related researches,several microRNAs expressing abnormally in IgA nephropathy was found.

Objective] To summarize professor Shen Hong's clinical experience in treating chronic atrophic gastritis. [Method] By following the teacher clinic and sorting out the related medical materials, the author summarizes professor Shen Hong's academic experience of treatment of chronic atrophic gastritis, and for proven cases. [Result] Professor Shen Hong thinks that the essence of pathogenesis is the weakness of the spleen and stomach. Qi stagnation, damp stagnation and blood stasis are common pathological factors. The characteristic of the disease is deficiency in origin and excess in superficiality. The location of disease is in stomach, relating to liver and spleen. The principle of treatment should be strengthening the spleen and stomach. It is also very important to treat accompanying symptoms and balance property of Chinese medicines. Prof. Shen emphasizes the combination of disease and syndrome differentiation and the integration of TCM and western medicine. He attaches much weight to diet and psychotherapy. The medication is concise and the prescription changes flexibly with the permitted addition and subtraction. The clinical curative effect is satisfactory. [Conclusion] Professor Shen Hong 's experience is effective and worthy of inheritance and promotion.

Objective To review the relationship between T helper cell 1/T helper cell 2 (Th1/Th2) shift and tumor recurrence. Methods Literatures on Th1/Th2 shift and tumor recurrence were collected and reviewed. Results Th1/Th2 shift can be detected in the host after therapy of the tumor. Tumor cells escape from host immune surveillance by altering Th1/Th2, which could lead to tumor recurrence. Conclusion Th1/Th2 shift is related to tumor recurrence after therapy. Impelling the reverse of Th2 to Th1 and renewing the balance of T helper cells come out to be a new way for tumor therapy.

Child ; Cyclophosphamide ; therapeutic use ; Humans ; Immunosuppressive Agents ; therapeutic use ; Nephrotic Syndrome ; drug therapy ; Treatment Outcome