Objective To investigate the myocardial injury effects of intrathecal morphine injection in elderly patients undergoing thoracoscopic lobectomy.Methods Fifty-five elderly patients undergoing elective thoracoscopic lobectomy,28 males and 27 females,aged 65-85 years,BMI 18.5-27.9 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups using the digital random allocation method:the control group(group C,n=28)and intrathecal morphine group(group M,n=27).Group M was given a single injection of morphine 4 pig/kg in the L2-3 space before surgery.General anesthesia was used in both groups,and single-lung ventilation was performed with double-lumen endotracheal intubation.Venous blood was collected before induction,24 and 48 hours after the operation to measure the levels of N-terminal brain natriuretic peptide precursor(NT-proBNP),creatine kinase isoenzyme(CK-MB),high-sensitivity troponin T(hs-TnT)and C-reactive protein(CRP).The incidence of myocardial injury after noncardiac surgery(MINS)was recorded.The intraoperative remifentanil dosage was recorded and the VAS pain scores at rest and during activity at 6,12,24,and 48 hours postoperatively were evaluated.The number of effective pa-tient-controlled intravenous analgesia(PCIA)compressions,the total number of PCIA compressions,the times of remedial analgesia in the postoperative period of 48 hours,as well as the incidence of postoperative adverse reactions(respiratory depression,nausea and vomiting,urinary retention,and pruritus)were re-corded.Postoperative 30-day major adverse cardiovascular and cerebrovascular events were recorded.Results Compared with preoperative,the levels of serum NT-proBNP,CK-MB,hs-TnT,and CRP were significantly higher in both groups at 24 and 48 hours postoperatively(P＜0.05).Compared with group C,the elevated levels of serum NT-proBNP,CK-MB,hs-TnT,CRP,and absolute hsTnT changes were signifi-cantly lower in group M 24 and 48 hours after operation(P＜0.05),the incidence of MINS was signifi-cantly lower in group M(P＜0.05).Compared with group C,the VAS pain scores of patients in group M were decreased significantly 6,12 and 24 hours during activity and 12 and 24 hours at rest after surgery(P＜0.05),the dosage of intraoperative remifentanil,the number of effective and total postoperative PCIA compressions,and the incidence of need for postoperative remedial analgesia were significantly reduced in group M(P＜0.05).There was no significantly difference in the incidence of postoperative adiverse reca-tions between the two groups.Conclusion Intrathecal morphine can reduce the levels of markers of myo-cardial injury in elderly patients undergoing thoracoscopic lobectomy,which plays a partial role in myocardial protection.

Objective:To construct NMB0315 eukaryotic expression recombinant vector ,detect specific humoral and cellular immune response induced by the recombint DNA vaccine intramuscularly in female BALB /c mice,evaluate the immunocompetence and immunoprotection of the vaccine , so as to provide experimental basis for the development of a novel nucleic acid vaccine against N.meningitidis serogroup B .Methods: The whole NMB0315 gene was amplified by PCR from the standard strains MC 58 genomic DNA,cloned into a plasmid pcDNA3.1(+),identified by double digestion of the recombinant plasmid with restriction enzymes and se -quencing.The recombinant vector pcDNA 3.1 (+)/NMB0315 was transfected into eukaryotic COS-7 cells and RAW264.7 cells, the NMB0315 protein was detected by immunocytochemical method and Western blot respectively .The levels of specific humoral and cellular immune response were detected after inoculating in female BALB /c mice intramuscularly with the recombinant plasmid .The immune protective effect was investigated with the DNA vaccine and the bactericidal titer of the immune serum was deter mined by serum bactericidal assay ( SBA ) in vitro.Results: The recombinant pcDNA3.1 (+)/NMB0315 was effectively transcripted and expressed in eukaryotic cells and the specific humoral and cellular immune responses were induced in the inoculated mice .In the re-combinant pcDNA3.1(+)/NMB0315 group ,the levels of serum IgG,IgG1,IgG2a,IgG2b and IgG3 and genital tract sIgA were significantly higher than in controls ( P<0.001 ) .The stimulation index in the culture supernatant of the spleen lymphocytes of the vaccine group was higher than that of the control group (P<0.05).The ratios of serum IgG2a/IgG1 in the DNA vaccine group were less than 1.The bactericidal titer of the NMB 0315+CpG group reached 1:128 following three immunizations , the protection rate of the vaccine group was 70%against the N.meningitidis strain MC58.Conclusion:The NMB0315 nucleic acid vaccine could induce higher levels of humoral immunity and cellular immunity and showed effective protection against N .meningitidis serogroup B , the immune serum had strong bactericidal activity in vitro .

Objective To observe effects of four extracts (water, n-butanol, acetoacetate and petro-leum benzine extracts) from Hippocampus japonicus on kidney-yang deficiency mice induced by extradiol, and reveal the modern scientific connotation about sweet-flavor, warm-nature, meridian tropism in liver and kidney. Methods Kidney-yang deficiency mice was induced by intraperitoneal injection of estradiol benzoate. Effects of four extracts from H. japonicus were observed by measuring physical signs, rectal temperature, grip strength, swimming time, autonomic mobility, creatinine (Cr) and urea (UR) level in serum, haematological indexes, testis index and seminal vesicle index. Results All the four extracts from H. japonicus could markedly improve physical signs and increase seminal vesicle index, RBC, Hb and PLT in blood, and decrease UR level in serum of kidney-yang deficiency mice, water extract and petoleum benzine extract could increase rectal temperature, grip strength, swimming time, autonomic mobility, testis index, WBC, lymphocyte (LY), monocyte (MO), and neutrophilic granulocyte (NE), n-butanol extract could increase autonomic mobility and NE, acetoacetate extract could enhance grip strength and prolong swimming time. Conclusion All above effects of extracts from H. japonicus could be as the basic of improving kidney-yang deficiency, could be an important part of the modern scientific connotation about sweet-flavor, warm-nature, meridian tropism in liver and kidney. Effects of water extract and petroleum ether extract were closer and stronger, which offer enlightenment for searching the common effective substance groups of H. japoniacs.

Objective To explore the clinical effect of the open and laparoscopic surgery in the treatment of ectopic pregnancy to retain the clinical efficacy of reproductive function analysis. Methods Four hundred and fifty-six patients with ectopic pregnancy were selected as our subjects. Two hundred and eleven cases were served as laparotomy group( open),and 245 cases were laparoscopic group( laparoscopic). The data of intraoperative blood loss,operative time,postoperative anal exhaust time,average hospital stay,tubal patency rate,intrauterine pregnancy rate and again repeat ectopic pregnancy rate were recorded. Results Patients in two groups were successfully completed surgery. The operative time,intraoperative blood loss,postoperative anal exhaust time,average hospitalization time were(55. 1 ± 13. 5)min,(63. 5 ± 18. 3)ml,(25. 7 ± 5. 6)h,(6. 1 ± 2. 0)d respectively in laparotomy group,and(41. 3 ± 15. 5)min,(41. 1 ± 13. 3)ml,(13. 5 ± 5. 1)h,(3. 6 ± 1. 4)d respectively in laparoscopic group,and the differences were significant( t =2. 045,2. 263,3. 131, 3. 152,P﹤0. 05). The tubal patency rate,intrauterine pregnancy,ectopic pregnancy rate in laparotomy group were 81. 0%( 171/211 ),59. 7%( 126/211 ) and 26. 5%( 56/211 ) respectively,and 75. 5%( 185/245 ), 53. 5%( 131/245 ) and 22. 9%( 56/245 ) respectively in laparoscopic group,and the differences were not significant(χ2 =2. 254,2. 130,1. 242;P ﹥0. 05 ). Conclusion Laparoscopic surgery in the treatment of ectopic pregnancy is superior to laparotomy in terms of small trauma,less bleeding,faster recovery,shorter hospitalization time,and postoperative tubal patency rate.

Objective:To evaluate the efficacy of perioperative analgesia with esketamine in the patients undergoing thoracoscopic surgery.Methods:A total of 90 patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy under general anesthesia, were divided into 3 groups ( n=30 each) by a random number table method: control group (C group) and different doses of esketamine groups (S 1 group, S 2 group). Before induction of anesthesia, esketamine 0.1 and 0.2 mg/kg were intravenously injected in S 1 group and S 2 group, respectively, while esketamine was not given in group C. Anesthesia was routinely induced in all the three groups. During anesthesia maintenance, esketamine 0.1 and 0.2 mg·kg -1·h -1 were intravenously infused in group S 1 and group S 2, respectively, and the remaining drugs used for anesthesia maintenance were the same in the three groups. Patient-controlled intravenous analgesia (PCIA) was used after operation, and PCIA solution contained sufentanil 2 μg/kg in group C, and esketamine 1 mg/kg was mixed on the basis as previously described in S 1 and S 2 groups. Aminotriol ketorolac was given as rescue analgesia to maintain numeric rating scale score at rest ≤3. The total amount of propofol and remifentanil during operation, effective pressing times of PCIA in postoperative 0-24 h and >24-48 h periods, and requirement for rescue analgesia were recorded. The occurrence of adverse reactions such as respiratory depression, nausea and vomiting, dizziness and salivation, and emergence time were recorded after surgery. The serum interleukin-6 (IL-6) concentration was measured by enzyme-linked immunosorbent assay at 30 min before and after surgery, and the malondialdehyde (MDA) concentration in serum was measured by thiobarbituric acid colorimetric analysis. The postoperative recovery was assessed using the 50-item quality of recovery scale at 1 and 2 days after surgery. The development of chronic pain was followed up by telephone within 1-3 months after surgery. Results:Compared with group C, the intraoperative consumption of remifentanil, effective pressing times of PCIA in postoperative 0-24 h and >24-48 h periods, rate of rescue analgesia, and postoperative serum IL-6 concentration were significantly decreased, and the 50-item quality of recovery scale score was increased in S 1 and S 2 groups, and the postoperative serum MDA concentration was significantly decreased in group S 2 ( P<0.05). Compared with group S 1, the consumption of intraoperative remifentanil was significantly decreased ( P<0.05), and no significant change was found in postoperative serum IL-6 and MDA concentrations in group S 2 ( P>0.05). Compared with group S 2, the postoperative emergence time was significantly shortened in S 1 and C groups ( P<0.05). There was no statistically significant difference in the intraoperative consumption of propofol, incidence of adverse effects and incidence of chronic pain among the three groups ( P>0.05). Conclusions:Esketamine for perioperative analgesia (dose before anesthesia induction 0.1 mg/kg, dose for maintenance of anesthesia 0.1 mg·kg -1·h -1, dose for postoperative PCIA 1 mg/kg) can raise the quality of analgesia and improve the quality of early postoperative recovery in the patients undergoing thoracoscopic lobectomy.

Objective To explore the effect of health education combine with nursing intervention on improving the awareness of patients′ tuberculosis ( TB) knowledge effectiveness. Methods A total of 1 186 cases of TB from June 2012 to June 2014 in our hospital were selected. According to accepted care measures, patients were divided into two groups, 593 cases received health education combined with nursing intervention were as the observation group, while another 593 cases received conventional care were as the control group. The questionnaires about TB knowledge, vital signs and prognosis of patient satisfaction outcomes were analyzed. Results Before accepting health education, the difference of knowledge of TB between the two groups was not statistically significant (P>0. 05). After the health education combined with nursing intervention, 540 (91. 1%) patients in the observation group got a score of TB knowledge over 60, which was significantly higher than 402 patients (67. 8%) in the control group (P<0. 05). 402 (67. 8%) patients in the observation group got a score of TB knowledge over 80, which was significantly higher than 207 patients (34. 9%) in the control group (P<0. 05). The total score of quality of life in the observation group were (603. 6 ± 127. 4), which was significantly higher than (512. 9 ± 114. 9) in the control group (t =2. 59,P<0. 05). The rate of satisfaction in observation group was significantly higher than that in the control group (Z=91. 3,P<0. 05). Conclusions Health education combined with nursing intervention can effectively improve the knowledge and awareness of TB patients. The psychological status and quality of life had significantly enhanced, thus it is worthy of further promotion in clinical practice.

Objective To investigate the effect of Hospital-Community-Family integrated management in the rehabilitation of patients with chronic gastric ulcer. Methods From June 2012 to June 2014, a total of 250 patients with chronic gastric ulcer were divided into the observation group ( n=125 ) and the control group (n=125) according to the random number table. After discharged from the hospital, the control group was given the conventional follow-up, the observation group was given Hospital-Community-Family integrated management. The scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS) and general quality of life inventory ( GQOLI-74 ) when discharging and 12 weeks after discharged were compared between two groups. Results At 12 weeks after discharged, the scores of SAS and SDS of the observation group were (45.3 ±10.2) and (44.1 ±9.9), which were significantly lower than those of the control group (t=3.857, 3.991;P < 0. 01). The score of GQOLI-74 of the observation group was (265. 0 ± 23. 6), which was significantlylowerthan(252.9±23.1)ofthecontrolgroup(t=4.097,P<0.01).Conclusions Inpatients with chronic gastric ulcer, Hospital-Community-Family integrated management can relieve anxiety and depression. It is conducive to the rehabilitation of patients and worthy of clinical promotion.

Objective To observe the effect of pressure-controlled ventilation volume-guaranteed(PCV-VG)mode on respiratory mechanics,lung injury markers and postoperative pulmonary complications(PPCs)in thoracoscopic patients.Methods Fifty-nine patients undergoing elective thoracoscopic lobecto-my,29 males and 30 females,aged 18-64 years,BMI 18.5-26.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups using a random number table method:the PCV-VG mode group(group P,n=29)and the volume-controlled ventilation(VCV)mode group(group V,n=30).The PCV-VG mode was used for one-lung ventilation(OLV)in group P,and the VCV mode was used in group V.Anesthesia in-duction and maintenance medications were consistent in all patients.PaO2 was recorded before induction of anesthesia,5 minutes after intubation,15 minutes after OLV,30 minutes after OLV,and 3 days postopera-tively,and oxygenation index(OI)and intrapulmonary shunt rate(Qs/Qt)were calculated.Peak airway pressure(Ppeak),pulmonary dynamic compliance(Cdyn),and driving pressure(DP)were recorded 5 minutes after intubation,15 minutes after OLV,and 30 minutes after OLV.Clara cell secretory protein-16(CC-16)and interleukin-6(IL-6)concentration were measured before induction of anesthesia and after ex-tubation.Recording the occurrence of PPCs within 1 week after surgery.Results Compared with group V,Ppeak and DP were significantly reduced,Cdyn was increased significantly in group P 15 minutes and 30 minutes after OLV(P＜0.05),PaO2 and OI were significantly increased in group P 3 days postoperatively(P＜0.05),CC-16 and IL-6 concentrations were significantly reduced in group P after extubation(P＜0.05).Compared with group V,the incidence of PPCs was significantly reduced in group P(P＜0.05).Conclusion During one-lung ventilation for thoracoscopic surgery,the pressure-controlled ventilation vol-ume-guaranteed mode reduces peak airway pressure and driving pressure,improves pulmonary dynamic compliance and improves oxygenation,reduces the incidence of PPCs.

Background and objectiveRadiofrequency ablation (RFA) has become one of the local treatment for inoperable early stage non-small cell lung cancer (NSCLC). hTis study observes effectiveness and safety of computed tomog-raphy (CT) guided RFA followed intratumoral chemotherapy (RFA-ITC).MethodsFrom 2005 to 2015, our group perspec-tively enrolled inoperable early stage NSCLC underwent RFA-ITC duo to poor cardiopulmonary function or with other dis-eases or patient can't tolerate or reject surgery. RFA was performed by a directive apparatus assisted CT guided semi real-time and step-by-step puncture method, conformal umbrella-shaped electrode and single or multiple targets ablation. While the plan ifnished and CT showed normal lung tissue around the tumor present ground-glass opacity (GGO), the procedure ended, then 200 mg of carboplatinum were injected into the tumor via the electrode needle. Safety and effectiveness were evaluated byfollow-up.Results Technical success rates of 125 RFA-ITC treatments of 110 patients were 100%. hTe median survival was 48.0 months, overall survival (OS) was 55.4 months, progression-free survival was 55.1 months, 1, 2, 3, 5-year OS rates were 100%, 90.7%, 62.7%, 21.9%, respectively. Survival of GGO presence or not was 68.3 months and 40.1 months, respectively (P=0.001). hTe survival rates of the N1 staging and tumor size was no signiifcant difference. No perioperative deaths occurred, the main complicationsi.e. pneumothorax, pulmonary hemorrhage, pleural effusion, fever, intraoperative chest pain, subcuta-neous emphysema, intraoperative cough were slight and tolerable.ConclusionCT guided RFA-ITC provides a good method for treatment of inoperable early stage NSCLC with better survival, less complication and small damage.