Objective To evaluate the effects of different rates of remifentanil infusion on cardiovascular response to tracheal intubation in older patients. Methods Thirty ASA Ⅰ-Ⅲ patients aged 65-75 yrs weighing 50-80 kg scheduled for elective abdominal operation were randomly divided into 3 groups (n = 10 each) according to the remifentanil infusion rate: group A 0.05 ?g?kg-1?min-1; group B 0.1 ?g?kg-1?min-1 and group C 0.15 ?g ?kg-1?min-1. The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Radial artery and subclavian vein were cannulated for BP and CVP monitoring and blood sampling. ECG, BP, HR and SpO2 were monitored during anesthesia. After 10 min stabilization induction of anesthesia was commenced with remifentanil infusion for 10 min. Midazolam 0.1 mg?kg-1 was then given Ⅳ. Succinylcholine 1.5 mg?kg-1 was given to facilitate intubation after the patients lost consciousness. BP and HR were recorded immediately before induction of anesthesia (T0, baseline), immediately after intubation (T1 ) and at 2, 5 and 10 min after intubation (T2 ,T3 ,T4 ) . Cardiovascular intubation response was defined as increase in SP or HR by 15% of the baseline value within 2 min after intubation. Blood samples were taken at T0-4 for determination of plasma concentration of norepinephrine (NE) and epinephrine (E) by HPLC. Side effects such as chest wall rigidity and hypotension were also recorded. Results The cardiovascular intubation response rate was significantly higher in group A (80%) than in group B (10% ) and C (10% ) . The incidence of side effects was significantly higher in group C (70% ) than in group B (20%) and A. Plasma NE and E concentrations were significantly increased after intubation in group A (at T2-4) and B (at T2,3) as compared with baseline values at T0; while in group C only plasma NE concentration was significantly increased at T2 and T3 and there was no significant change in plasma E concentration after intubation. The plasma NE and E concentrations were significantly higher in group A (T2-4) and B (T2,3) than in group C. Conclusion The appropriate infusion rate of remifentanil for tracheal intubation is 0.10 ?g?kg-1 ?min-1 in older patients.

OBJECTIVE To enhance reasonable usage of antibiotics and develop hospital infection management for monitoring,managing and improving of antibiotics clinical administration.METHODS Six Sigma analysis methods were used to identify key points in the quality management process.Based on these points,hospital infection management software was developed and its effects were evaluated using statistical analysis methods.RESULTS In perioperative period of Ⅰ surgical incision,the proportion of prophylactic antibiotics usage decreased significantly.The treatment time of antibiotics within 72 hours perioperative period was significantly shorten after software application.Total amount of antibiotics was significantly declined,dropped by 21.01%;Meanwhile,the administration amount of antibiotics classified in special use decreased,dropped by 21.7%.The microbial distribution,drug resistance and consumption monitoring could be understanded immediately.CONCLUSIONS The software can make us immediately know the dynamic consumption of antibiotics and trends of bacterial resistance in hospital to decrease the irrational use of antibiotics.

To analyze features of the rabies epidemic in China between 2007 and 2011,identify factors influencing the epidemic and to provide a scientific basis for further control and prevention of rabies,Descriptive epidemiological methods and statistical analysis was used on data collected from the National Disease Reporting Information System between 2007 to 2011 and the National Active Surveillance System between 2007 and 2010.Our analysis shows that while the number of human rabies cases decreased year by year,the number of districts reporting cases did not show significant change.The situations in Guangdong,Guangxi,Guizhou and Hunan provinces clearly improved over the period but they remain provinces with high-incidence,and consequently influence the epidemic situation of surrounding provinces and possibly the whole country.Summer and autumn were high-incidence seasons.Farmers,students and pre-school children represent the high-risk populations,and rates of cases in farmers increased,those for students decreased,and pre-school children remained unchanged.Provinces with active surveillance programs reported a total of 2346 individual cases,of which 88.53％ were associated with canines.Postexposure prophylaxis (PEP) of rabies cases was not significantly improved,whereas PEP in post-exposure population was good.In rural regions of China,canine density was reduced somewhat,and the immunization rate increased slightly.Finally we show that while the epidemic decreased 2007 to 2011 in China,cases continued to be diffused in certain regions.Lack of standardization of PEP on rabies cases was the main reason of morbidity.The high density and low immunization of dog in rural areas and the defective situation of PEP are still continuous occurrences in China and remain a cause for concern.

To investigate the knowledge, attitude and practice (KAP) on rabies among a mass of the exposed population in Beijing so as to provide scientific evidence for development of measures on the prevention and protection of rabies, the descriptive studies were employed, in which patients were interviewed face to face with a standard questionnaire in hospital or the center for disease control and prevention (CDC), including history of exposure, knowledge on rabies, post-exposure treatment etc. Of 478 respondents, 76% of them were bitten on the upper limbs with the exposure proportions in category Ⅰ, Ⅱ and Ⅲ of 24%, 70% and 6% respectively. The proportions of awareness of knowledge in rabies before biting, its prevention, the correct measure to treat their wounds themselves, rabies vaccine inoculation, and injections with rabies antiserum constituted in 82%, 55%, 59%, 99% and 22% respectively. Result of this investigation indicates that most of the people investigated had a lower awareness of knowledge on rabies, the correct measures to treat rabies after biting as well as the measures to prevent rabies, suggesting that community-based prevention and control measures should be emphasized, especially targeting the population with high risk and the heath education on rabies should performed promptly by several governmental departments.

Objective To investigate the protective effect of thyroid hormone on spinal cord injury neurons and its molecular mechanism.Methods A DMEM culture medium with a volume fraction of 10％ fetal bovine serum was cultured with the dorsal ridge neurons of RN-dsc rats.The neurons were inoculated in the culture plate after the digestion of trypsin and treated differently as follows:(1) control group:DMEM treatment with no drugs or serum;(2) H2O2 group:serum-free DMEMtreatment containing 100 μmol/L H2O2;(3) H2O2 + 10-6 mol/L triiodothyronine (T3) group:serumfree DMEM treatment containing 100 μnol/L H2O2 and 10-6mol/L T3;(4) H2O2 + 10-5 mol/L T3 group:serum-free DMEM treatment containing 100 μ mol/L H2O2 and 10-5 mol/L T3;(5) negativecontrol group:transfection of negative control mimics with LipofectamineTM2000 reagent;(6) miR-210 group:transfection of miR-210 mimics with LipofectamineTM 2000 reagent.Cell viability,apoptosis number,and expressions of nuclear factor E2 correlation factor 2 (Nrf-2) antioxidant pathway molecules and miR-210 were determined.After transfection of miR-210 mimics and negative control mimics,expressions of Nrf-2 antioxidant pathway molecules were determined.Results The cell proliferation activity and protein expressions of Nrf-2,antioxidant reaction elements (ARE),superoxide dismutase 2 (SOD2),and heme oxygenase (HO-1) in H2O2 group (0.39 ±0.06,0.52 ±0.08,0.31 ±0.08,0.25 ± 0.05,respectively) were significantly lower than those in control group (1.00 ± 0.15,1.00 ± 0.17,1.00 ± 0.13,1.00 ± 0.11,respectively) (P ＜ 0.05),while the apoptosis numbers and the expressions of miR-210 were significantly higher than those in control group (P ＜ 0.05).The cell proliferation activity and protein expressions of Nff-2,ARE,SOD2,HO-1 in H2O2 + 10-6mol/L T3 group and H2O2 +10-5 mol/L T3 group were significantly higher than those in the H2O2 group (P ＜ 0.05),while apoptosis numbers and expressions of miR-210 were significantly lower than those in H2O2 group (P ＜ 0.05).The cell proliferation activity and protein expressions of Nrf-2,ARE,SOD2,HO-1 in H2O2 + 10-5mol/L T3 group (0.88 ±0.14,0.84 ±0.12,0.72 ±0.09,0.69 ±0.09) were significantly higher than those in H2O2 + 10-6mol/L T3 group (0.73 ±0.09,0.71 ±0.08,0.58 ±0.09,0.52 ±0.08) (P＜0.05),while apoptosis numbers and expressions of miR-210 were significantly lower than those in H2O2 + 10-6mol/L T3 group.The protein expressions of Nrf-2,ARE,SOD2,and HO-1 in miR-210 group (0.37 ±0.06,0.24 ±0.05,0.45 ± 0.08,0.49 ± 0.07,respectively) were significantly lower than those in negative control group (1.00±0.13,1.00±0.19,1.00±0.15,1.00±0.14,respectively) (P＜0.05).Conclusion Thyroid hormone can inhibit the expression of Nrf-2 in oxidative stress injury process of neurons by inhibiting the expression of miR-210,and hence reduce the oxidative stress injury of spinal cord neurons.

Objective: To evaluate the efficacy and safety of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) 25/150/100 mg once daily and dasabuvir (DSV) 250 mg twice daily combined with ribavirin in adult patients of Mainland China with chronic HCV genotype 1b infection and compensated cirrhosis. Methods: An open-label, multicenter, phase 3 clinical trial study was conducted in mainland China, Taiwan, and South Korea. Adult patients with compensated cirrhosis (Metavir score =F4) who were newly diagnosed and treated for hepatitis C virus genotype 1b infection with ombitasvir/paritaprevir/ritonavir and dasabuvir combined with ribavirin for 12 weeks were included. Assessed SVR rate of patients obtained at 12 and 24 weeks after drug withdrawal. Efficacy and safety were evaluated in patients who received at least one time study drugs. Results: A total of 63 patients from mainland China were enrolled, 62 of whom (98.4%) had a baseline Child-Pugh score of 5 points. The overall rate of SVR12 and SVR24 in patients was 100% (95% CI: 94.3% to 100.0%). Most of the adverse events that occurred were mild. The incidence of common (≥10%) adverse events and laboratory abnormalities included elevated total bilirubin (36.5%), weakness (19.0%), elevated unconjugated bilirubin (19.0%) and conjugated bilirubin (17.5%), and anemia (14.3%). Three cases (4.8%) of patients experienced Grade ≥ 3 adverse events that were considered by the investigators to be unrelated to the study drug. None patients had adverse events leading to premature drug withdrawal. Conclusion Mainland Chinese patients with chronic HCV genotype 1b infection and compensated cirrhosis who were treated with OBV/PTV/r plus DSV combined with RBV for 12 weeks achieved 100 % SVR at 12 and 24 weeks after drug withdrawal. Tolerability and safety were good, and majority of adverse events were mild.

Objective: To evaluate the safety and efficacy of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) 25/150/100 mg once daily combined with dasabuvir 250mg, twice daily in non-cirrhotic Chinese adult patients with newly diagnosed and treated chronic HCV genotype 1b infection. Methods: A randomized, double-blind, placebo-controlled, multicenter phase 3 clinical trial was conducted in mainland China, Korea, and Taiwan.Safety and efficacy of OBV/PTV/r plus DSV administered for 12 weeks were evaluated in a newly diagnosed and treated (interferon alpha /pegylated interferon alpha) and ribavirin non-cirrhotic adults with chronic HCVgenotype 1b infection. Patients randomly received OBV/PTV/r plus DSV for 12 weeks (Group A), or placebo for 12 weeks (Group B) followed by an open-label phase of OBV/PTV/r plus DSV for 12 weeks. Sustained response (SVR12) rate obtained at 12 weeks and (SVR24) 24 weeks after discontinuation of treatment, and the incidence of adverse events and laboratory abnormalities after double-blind and open-label phase treatment were assessed. Results: A total of 410 cases of Chinese patients were included and randomly assigned to group A and B (with 205 cases in each group) in a 1:1 ratio. The rates of SVR12 and SVR24 were 99% (95% CI: 94.8% - 99.8%) in the newly diagnosed patients in group A (205 patients) and the rates of SVR12 and SVR24 were 100% in treated patients (95% CI: 96.3% - 100%). Different baseline characteristics had no effect on SVR12 and SVR24 rates. Most of the adverse events occurred were mild, asymptomatic, and≥ 3 laboratory abnormalities during treatment were rare, including elevation of alanine aminotransferase (2 cases in double-blind stage A group), aspartate aminotransferase (Double-blind stage A (3 cases) and total bilirubin (1 case in open-label phase B group); however, those mild adverse events could be recovered after drug withdrawal or discontinuation. only1 person discontinued drugs due to adverse events (Group B, open-label phase). Conclusion The 12 weeks treatment course of OBV/PTV/r combined with DSV produced 99% ~ 100% rates of SVR12 and SVR24 in non-cirrhotic Asian adult patients with newly diagnosed and treated chronic HCV genotype 1b infection, and the tolerance and safety were good.

BACKGROUNDFirst generation drug-eluting stents (DES) were associated with a high incidence of late stent thrombosis (ST), mainly due to delayed healing and re-endothelization by the durable polymer coating. This study sought to assess the safety and efficacy of the Nano polymer-free sirolimus-eluting stent (SES) in the treatment of patients with de novo coronary artery lesions.

METHODSThe Nano trial is the first randomized trial designed to compare the safety and efficacy of the Nano polymer-free SES and Partner durable-polymer SES (Lepu Medical Technology, Beijing, China) in the treatment of patients with de novo native coronary lesions. The primary endpoint was in-stent late lumen loss (LLL) at 9-month follow-up. The secondary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction or target lesion revascularization.

RESULTSA total of 291 patients (Nano group: n = 143, Partner group: n = 148) were enrolled in this trial from 19 Chinese centers. The Nano polymer-free SES was non-inferior to the Partner durable-polymer DES at the primary endpoint of 9 months (P < 0.001). The 9-month in-segment LLL of the polymer-free Nano SES was comparable to the Partner SES (0.34 ± 0.42) mm vs. (0.30 ± 0.48) mm, P = 0.21). The incidence of MACE in the Nano group were 7.6% compared to the Partner group of 5.9% (P = 0.75) at 2 years follow-up. The frequency of cardiac death and stent thrombosis was low for both Nano and Partner SES (0.8% vs. 0.7%, 0.8% vs. 1.5%, both P = 1.00).

CONCLUSIONSIn this multicenter randomized Nano trial, the Nano polymer-free SES showed similar safety and efficacy compared with the Partner SES in the treatment of patients with de novo coronary artery lesions. Trials in patients with complex lesions and longer term follow-up are necessary to confirm the clinical performance of this novel Nano polymer-free SES.

Aged ; Coronary Artery Disease ; drug therapy ; surgery ; Drug-Eluting Stents ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Middle Aged ; Prospective Studies ; Sirolimus ; therapeutic use