ObjectiveTo investigate the effect of dexmedetomidine on postoperative intracranial pressure (ICP) in patients with severe brain injury.MethodsNinety ASA Ⅱ or Ⅲ patients with severe brain injury,aged 19-64 yr,with Glasgow coma scale 3-7,undergoing emergency craniotomy,were randomly divided into 3 groups (n =30 each):control group (group C) and 2 different doses of dexmedetomidine groups (groups D1,D2 ).Anesthesia was induced with propofol 1.5-2.0 mg/kg,fentanyl 4 μg/kg and vecuronium 0.1 mg/kg and maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of vecuronium.The patients were mechanically ventilated after tracheal intubation.Dexmedetomidine 0.3 and 0.7 μg· kg- 1· h- 1 were infused after tracheal intubation in groups D1 and D2 respectively and the infusion was maintained for 48 h.ICP was monitored after operation and maintained ＜ 30 mm Hg by iv injection of hexadecadrol,mannitol and glycerol fructose within 2 d after operation.Venous blood samples were obtained from peripheral vein after anesthesia induction and at 6,12 and 24 h after operation (T0-3) for determination of sertum IL-1β and TNF-α concentrations by ELISA.The clinical results were evaluated using Glasgow prognosis score at 3 months after operation.The amount of hexadecadrol,mannitol and glycerol fructose consumed during 2 d after operation was recorded.ResultsCompared with T0,serum IL-1βand TNF-α concentrations were significantly higher at T1-3 in the three groups ( P ＜ 0.05).The serum IL-1β and TNF-α concentrations at T1-3 and the amount of hexadecadrol,mannitol and glycerol fructose consumed were significantly lower,and the clinical results were significant better in groups D1 and D2 than in group C,and in group D2 than in group D1 ( P ＜ 0.05).ConclusionDexmedetomidine can reduce postoperative ICP in patients with severe brain injury in a dose-dependent manner which is helpful for improving prognosis.The decrease in IL-1β and TNF-α levels and inhibition of inflammatory response may be involved in the mechanism.

Objective To explore the clinical risk factors influencing the short-term prognosis of transient ischemic attack(TTA).Methods We collected the clinical data of 162 patients with TIA in this study.All the patients were followed up for 90 days.Multiple factor analysis was performed by Cox regression model(SPSS 13.0 software).Results Within 90 days after TIA,40 of 162 patients(24.7%)experienced cerebral infarction.The risk of cerebral infaition during the first 30 days after TIA was higher.The independent risk factors for the prognosis within 90 days after TIA were the duration of TIA(RR=17.172,P＜0.01),hyperfibrinogenemia(RR=3.071,P＜0.01),abnormal blood glucose level(RR=2.651,P＜0.01),and hypertension(RR=3.356,P＜0.01).Conclusion The duration of TIA,hyperfibrinogenemia,abnormal blood glucose level,and hypertension are independent risk factors for the short-term prognosis of TIA.

Objective To investigate the effect of preemptive analgesia with parecoxib sodium on postoperative cognitive junction in the elderly patients.Methods Sixty ASA ⅠorⅡ patients aged 69-83 yr weighing 47-73 kg undergoing elective operation on the femoral head or hip joint were randomly divided into 2 groups (n=30 each):control group (group C) and parecoxib group (group P).Their preoperative mini-mental state examination scores were more than 23.Parecoxib sodium 40 mg in 5 ml normal saline was injected iv before induction of anesthesia in group P. Patient-controlled intravenous analgesia with fentanyl and tramadol was used in all patients. VAS score was maintained ≤3. If VAS score was more than 3, a bolus of fentanyl 0.2 μg/kg was given iv.Venous blood samples were taken at 1 day before and 1, 4, 24 and 72 h after operation for determination of plasma concentrations of cortisol.Cognitive function was assessed by mini-mental state examination. The total amount of fentanyl and tramadol consumed was recorded. Results Plasma cortisol concentrations and incidence of postoperative cognitive dysfunction were significantly lower and the total amount of fentanyl and tramadol consumed was smaller in group P than in group C.Conclusion Preemptive analgesia with parecoxib sodium 40 mg can reduce the incidence of postoperative cognitive dysfunction in the elderly patients.

Objective To evaluate the incidence of postanesthetic shivering in patients undergoing radical operation for lung cancer under dexmedetomidine-assisted anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 50-75 yr,height 158-180 cm,weighing 48-79 kg,scheduled for radical operation for lung cancer under general anesthesia combined with epidural anesthesia,were randomly divided into 2 groups ( n =40 each): normal saline control group (group C) and dexmedetomidine group(group D).Anesthesia was induced with midazolam,fentanyl,propofol and rocuronium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent epidural ropivacaine.BIS was maintained at 40-55.Group D received dexmedetomidine intravenous infusion at 0.5 μg · kg- 1· h- 1 from immediately after tracheal intubation until 1 h before the end of operation,and group C received the equal volume of normal saline.The shivering within 1 h after operation was scored and recorded.Results The incidence rate of postanesthetic shivering was 50％ in group C and 10％ in group D.Compared with group C,the incidence rate and degree of shivering were decreased in group D( P ＜ 0.05).Conclusion Dexmedetomidine-assisted anesthesia can reduce the incidence of postanesthetic shivering in patients undergoing radical operation for lung cancer.

Objective To investigate the association between serum ferritin(SF) level at early and mid trimester of pregnancy and gestational diabetes mellitus (GDM) and insulin resistance (IR).Methods A total of 192 cases of women who were accepted antenatal examination from the first trimester of pregnancy at Yueqing People Hospital from July,2012 to October,2013 was prospectively analyzed and followed up.All cases were divided into two groups:96 cases of GDM pregnant women who were diagnosed as GDM at mid trimester of pregnancy as GDM group,and 96 cases of pregnant women with normal glucose tolerance at the same time as the control,normal glucose tolerance (NGT group).The differences in clinical data were compared between two groups.The relationship between SF level and fasting plasma glucose (FPG),fasting insulin (FINS),homeostasis model assessment insulin resistance (HOMA-IR),and C-peptide was investigated with Spearman rank correlation analysis.The predictive values of SF and relative variables to GDM were calculated by receiver operating characteristic curve (ROC) or Logistic regression analysis.Results (1) There was statistically significant difference in body weight and body mass index (BMI) at prepregnancy and mid trimester of pregnancy,Hb,FPG,FINS,SF,and C-peptide at the first trimester of pregnancy,SF level and FPG and HOMA-IR and C-peptide at mid trimester of pregnancy between two groups (P ＜ 0.01 or P ＜ 0.05).(2) As showed by Spearman rank correlation analysis,there was statistical correlation between SF at mid trimester of pregnancy,and FPG,FINS,HOMA-IR and C-peptide (P ＜0.01 or P ＜ 0.05);while no statistical correlation was found between SF at the first trimester of pregnancy and the same factors above (P ＞ 0.05).(3) The area under the ROC curve of SF at mid trimester of pregnancy for GDM was 0.653.The sensitivity and specificity were 68.8％ and 59.4％ in predicting GDM at the cut-off value of 16.61 ng/ml.As showed by Logistic regression analysis,high level of SF at mid trimester of pregnancy was a independent risk factor for GDM.Odds ratio (OR) was 1.032 (95％ CI:1.008 ～ 1.058,P ＜ 0.01).Conclusions The relationship between SF at different trimester of pregnancy and GDM is variant.There is relationship between high level SF of mid trimester of pregnancy in GDM pregnant women and IR.The level of SF might predict the occurrence of GDM.

Presented in this paper is a report on the Quadriplegia Index of Function(QIF) in usewith 16 cases of quadriplegic patients.Compared with the Barthel Index and Japan ADL Scale,QIF wasfound to be more sensitive and effective to document the small but significant funtional gains made byquadriplegics during medical rehabilitation,therefore,authors suggest that QIF should be widely usedin the rehabilitation evaluation of quadriplegic patients.

Objective To compare the dosimetric differences in heart and lung among three radiotherapy techniques in the treatment of thoracic esophageal cancer. Methods A total of 15 thoracic esophageal cancer patients treated in Zhejiang Cancer Hospital during the period of January 2015 to February 2016 were enrolled in this retrospective dosimetric study. Three radiotherapy treatment plans, including intensity-modulated radiotherapy ( IMRT) , volumetric intensity modulated arc therapy ( VMAT) with Raystation 4. 0v TPS, and tomotherapy (TOMO) plans with TomoTTM v2. 0. 5 TPS were generated for each patient with a prescribed dose of 60 Gy at 2 Gy per fraction. Dosimetric differences in planning target volume ( PTV) , heart, cardiac subunits and lung were compared. Results The mean volumes of PTV, heart and lung were (399 ±355), (671 ±274) and (3907 ±1717)cm3, respectively. Compared with VMAT and IMRT, TOMO reduced the maximum dose of PTV, heart, left atrium and lung ( H=10. 889, 7. 433, 12. 080, 11. 401, P <0. 05). No difference was observed in conformity or homogeneity among these three plans. Conclusions TOMO reduced the maximum dose to PTV, heart, left atrium and lung compared with VMAT and IMRT, However, no difference in conformity and homogeneity was observed. The impact of dosimetric advantage of TOMO needs further verification due to the interaction between heart and lung for thoracic esophageal cancer patients.

Objective:To assess the prevalence of metabolic syndrome(MS) and its relationship with hyperuricemia(HUA) in perimenopausal women in Anning city, Yunnan province.Methods:This is a cross-sectional survey. In May 2021, a multi-stage stratified sampling method was used to collect demographics and clinical data [ethnicity, living community, height, weight, waist circumference, blood pressure, fasting plasma glucose, triglycerides(TG), serum uric acid, high density lipoprotein-cholesterol(HDL-C), alanine transaminase(ALT), etc] in a total of 6 721 perimenopausal women aged 45-60 years.Results:A total of 6 721 perimenopausal women were included in this study. The prevalences of MS and HUA were 14.05%(95% CI 13.22%-14.88%) and 6.46%(95% CI 5.88%-7.07%), respectively. The average age, HDL-C, urea, direct bilirubin, and albumin levels in the perimenstrual HUA population were lower than those in the non-HUA population while the levels of TG, ALT, heart rate, body mass index(BMI), and creatinine were higher(all P<0.05). The prevalence of HUA in perimenopausal women with ethnic minorities and family history of chronic diseases was higher than that in Han nationality and without family history of chronic diseases. The prevalence of MS in perimenopausal women was increased with the increase of serum uric acid( Z=-15.313 8, P<0.001). Multivariate logistic regression model showed that HUA was positively correlated with MS( OR=1.526, 95% CI 1.192-1.954) after adjusting for covariates such as BMI and ethnicity, and the incidence of MS in perimenopausal women in HUA group was 1.526 folds higher than that in non-hyperuricemia group. Conclusion:HUA is highly positively correlated with MS in perimenopausal women. The management of uric acid level in perimenopausal women should be strengthened.

Objective:To explore the effect of gene polymorphism on workers suffering from noise induced hearing loss (NIHL) .Methods:In May 2019, a case-control study was conducted to select noise exposed workers in five factories in Zhejiang Province from 2017 to 2018. The average hearing threshold of binaural high frequency (3, 4, 6 kHz) was >25 dB (A) as the NIHL group, and the hearing threshold of any language frequency (0.5, 1, 2 kHz) was ≤25 dB (A) as the non NIHL group, with 307 people in each group. The general demographic data, occupational history, pure tone audiometry results and oral swab mucosal samples of noise exposed workers were collected, and the DNA of oral mucosal cells was extracted. The relationship between genetic risk score (GRS) and NIHL was analyzed, single nucleotide polymorphisms (SNP) were genotyped, the relationship between genotype and NIHL was analyzed by logistic regression, and the relationship between haplotype and NIHL was analyzed by R language.Results:After adjusting for gender, age, education and working years, the risk of NIHL among workers carrying cysteine-aspartic acid protease 3 gene ( CASP3) rs1049216 recessive model GG genotype, rs6948 recessive model TT genotype, NADPH oxidase 3 gene ( NOX3) rs12195525 additive model GT genotype and dominant model TT+GT genotype decreased ( P<0.05) , the risk of disease was higher in workers with AA genotype carrying cysteine-aspartic acid protease 7 gene ( CASP7) rs12415607 additive model ( P<0.05) . There was a strong linkage disequilibrium (LD) relationship between rs1049216 and rs6948 ( D'>0.8) . Haplotype AT and GG composed of rs1049216-rs6948 increased the risk of NIHL ( P<0.05) . The risk of NIHL increased with the increase of GRS ( OR=2.69, P<0.05) . Conclusion:Genotype polymorphisms at rs1049216 and rs6948 ( CASP3) , rs12195525 ( NOX3) , rs12415607 ( CASP7) may be associated with susceptibility to NIHL.

Objective To understand the current status of primary hospital clinical nurses ’ critical thinking ability and self-learning ability and to explore the relationship between them , so as to provide theoretical basis and reference for continuing medical education .Methods Totals of 345 clinical nurses in three county hospitals were surveyed by general information questionnaire , Critical Thinking Disposition Inventory-Chinese Version ( CTDI-CV ) and nurse self-learning ability rating scale .Results The total score of clinical nurses ’ critical thinking ability was (276.08 ±34.31), and the self-learning ability score was (121.40 ±18.42). Based on the above results , Except that cognitive maturity had no significant correlation with task analysis , self-monitoring and regulation , critical thinking ability was positively related to self -learning ability and other dimensions (P <0.05).Conclusions The critical thinking and self-learning ability of clinical nurses in primary hospital need to be improved .Because of their mutual positive impact , nursing managers should take a variety of measures to develop and improve these abilities .