Objective To investigate the effect of nicardipine on perioperative insulin sensitivity in patients with essential hypertension(EH). Methods Thirty-eight patients undergoing lobectomy continuously after induction of anesthesia in group N, while normal saline was infused in group C instead of nicardipine. Blood samples were taken immediately before induction of anesthesia(T_0), 2 h after skin incision(T_1) ,4 h after surgery(T_2) and 24 h after surgery(T_3). Blood glucose(BG) and plasma insulin (Ins) were measured. The Insulin sensitivity index (ISI) was calculated. Results Values of BG at T_2and T_3 in group C were higher than those at T_0 (P<0. 05). Value of Ins at T_2 in group C was higher than that at T_0 (P<0. 05),which at T_3 in group C was significantly higher than that at T_0 (P<0. 01). ISI at T_2 in group C was lower than that at T_0 (P<0. 05) ,which at T_3 in group C was lower significantly than that at T_0 (P<0. 01). Values of BG and Ins at T_3 in group N were higher than those at T_0 (P<0. 05), ISI at T_3 in group N was lower than that at T_0 (P<0. 05). Value of BG at T_2 was significantly lower in group N than that in group C(P<0. 05). Value of Ins at T_3 was significantly lower in group N than that in group C(P<0. 01). ISI at T_2 and T_3 in group N was min~(-1) infused continuously during and after lobectomy can increase significantly insulin sensitivity and improve postopertive insulin resistance state in EH patients.

KCNK17 is a member of the acid-sensitive subfamily of tandem pore K(+) channels, which are open at all membrane potentials an red contribute to cellular resting membrane potential. Recent genome-wide study (GWA) has shown that variants within KCNK17 confer genetic susceptibility for increasing ischemic stroke. In an effort to discover additional polymorphism(s), we scrutinized the genetic polymorphisms in the KCNK17. By direct DNA sequencing in 32 individuals, we identified nine sequence variants within the 16 kb of whole KCNK17 gene: one in exon1, one in intron and seven in the promoter region. Haplotypes, their frequencies and linkage disequilibrium coefficients (D'), among polymorphisms were estimated. All the polymorphisms in the 5'-flanking region (SNP2-SNP7) being in complete (or nearly complete) association with each other in the promoter region maybe produce synergistic effect to regulate the expression of KCNK17 gene and then have an influence on the pathogenesis of cerebrovascular diseases. The common haplotypes were observed comprising 88.9% of the total haplotypes in the same block. Bioinformatic analysis predicted several potential transcriptional factors binding sites by SNP -95, -134, -596 and -846. However, these binding sites need to be experimentally verified. The information concerning genetic polymorphisms of KCNK17 gene might provide valuable information for future genetic studies of diseases.

Objective To investigate the association between gene polymorphism of plasminogen activator inhibitor (PAI-1)and ischemic cerebrovascular disease in aged people of Henan Han nationality.Methods A case control method was used,including 408 patients with ischemic cerebrovascular disease and 418 age and gender matched healthy controls.Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method was used to determine the distribution of allele and genotype frequencies of PAI-1 844G/A.Results In patient group,the gene frequencies of AA,AG,GG were 18.1％,41.4％,40.4％,and the A and G allele frequencies were 38.8％ and 61.2％,respectively.In the control group,the gene frequencies of AA,AG,GG were 15.8％,47.4％,36.8％,and the A and G allele frequencies were 39.5％ and 60.5％.There were no significant differences in the frequencies of genotypes and alleles between the two groups (P＞0.05).The different genotypes of 844G/A of PAI-1 gene were not associated with hypertension,hyperglycemia,plasma homocysteic acid levels (P ＞ 0.05).Conclusions PAI-1 gene-844G/A polymorphism may not be independent risk factor of ischemic cerebrovascular disease in aged people of Henan Han nationality.

Objective To identify the necessity to carry out optimization procedure in routine digital radiography (DR) by evaluating changes of patient radiation dose and image waste ratio before and after optimization.Methods Two hundred patients with near-standard body build were enrolled in the study.Half of them undertook routine examination,and the others undertook the examination with bestlyoptimized protocol.The dose-area product (DAP) and entrance surface dose (ESD) were recorded.The image waste ratios in 2 groups were calculated and the reasons for image waste were analyzed.The radiation dose and image waste ratio before and after optimization were compared.Results The ESD,DAP and image waste ratio in bestly-optimized radiography were significantly lower than those in non-optimized radiography (z =9.31,16.22,P＜0.05; x2 =36.5,P ＜ 0.05).Conclusion Using the bestlyoptimized digital radiography,the patient radiation dose and image waste ratio are effectively reduced.

Objective To summary the experience in surgical treatment of differentiated thyroid carcinoma (DTC).Methods The clinical data and follow-up results of 110 cases of DTC were retrospectively analyzed.Results 110 patients received operation and TSH suppress therapy.Histologic examination after operation revealed that papillary thyroid carcinoma(PTC) 88 cases(80%) ,follicular thyroid carcinoma 22 cases(20%) ,cervical lymph node metastasis were found in 22 cases(20%).The operation procedure consists of excision of the suffered lobe,isthmus and greater partial of the opposite lobe 59 cases(along with functional cervical dissection 12 cases) ;excision cf the sufferedlobe,isthmus 29 cases(along with functional cervical dissection 7 cases) ;excision of the suffered lobe,isthmus greater partial of the opposite lobe 18 cases(along with functional cervical dissection 5 cases) ;total thyroidectomy and bilateral cervical dissection 2 cases;total thyroidectomy and bilateral cervical dissection with postoperative 131I therapy,1 cases with metastasis to lung.98 cases 10-year survival rate was 91.8%.Conclusion Differentiated thyroid carcinoma has a good prognosis,a proper surgical procedure is the key point to get a good outcome.

Objective To evaluate the safety and effectiveness of Stoppa approach combined with iliac incision in periacetabular osteotomy for treatment of hip dysplasia.Methods From September 2011 to July 2012,18 patients (20 hips) with hip dysplasia were performed periacetabular osteotomy through Stoppa approach combined with iliac incision.There were 15 female patients with 17 hips and 3 male patients with 3 hips.The average age was 29 years old (range 19 to 35).The surgical incision included two parts with the abdominal transverse incision (Stoppa approach) and the iliac incision (the lateral window of ilioinguinal approach).The duration of surgery,length of incision,intraoperative blood loss,and amount of allogeneic blood transfusion were measured.The clinical function,radiographic parameters,and operative complications were analyzed at 12 months follow-up.Results The mean operation time was 145 min (range,125-180 min).The mean incision length of Stoppa approach was 7 cm (range,5-10 erm) for the abdominal part and 6 cm (range,4-8 cm) for the iliac part,and the average of total incision length was 13 cm (range,12-16 cm).The mean blood loss during operation was 800ml (range,500-1 600 ml).The mean amount of allogeneic blood transfusion was 1 161 ml (range,400-2 400 ml).The mean duration of follow-up was 19.6 months (range,14-22 months).Compared to the preoperative data,both postoperative Harris hip score and center-edge angle improved significantly,with a mean increase of 13.2±6.0 and 22.5°±4.5° respectively.The mean Harris hip score improved form 80.3±8.5 preoperatively to 93.5±5.2 postoperatively at the time of 12 months follow-up.The average center-edge angle improved from 7.5°±5.4° preoperatively to 30.0°±4.6° postoperatively.All of the osteotomies except two pubic osteotomies healed at the time of three months follow-up.The two pubic osteotomies were treated with protected weight bearing and had a delayed union until the six months follow-up.The mean time of osteotomies union was 3.3 months.Complications included three transient]ateral femoral cutaneous nerve palsies which completely resolved within three months after oral medicine therapy.There were no major neurovascular complications,no infection,no incision hernia or any other surgical complications.Conclusion Stoppa approach combined with iliac incision is a safe and effective approach for periacetabular osteotomy.It is an alternative to conventional ilioinguinal approach for treatment of mild hip dysplasia.

Objective To study the value of serum albumin ( ALB ) level for the prognosis of late-preterm infants infection. Methods Late-preterm infants admitted to the neonatal intensive care unit ( NICU) from July 2012 to July 2013 were recruited and their clinical data retrospectively reviewed, including the laboratory examination results, neonatal critical illness scores ( NCIS ) , perinatal complications and prognosis. The infants were assigned into three groups based on ALB levels (＞30 g/L, 25-30 g/L, ＜25 g/L). Results A total of 257 cases were recruited and 122 cases (47. 4％) had ALB levels ＜25 g/L. 32 had neonatal sepsis ( sepsis group) , 190 neonatal infection ( infection group) and 35 without infection ( no-infection group ) . The incidences of hypoalbuminemia among these groups were 84. 4％, 50. 0％ and 28. 6％, with the mortality rate 15. 6％, 0. 5％ and 0％. The incidence of hypoalbuminemia and mortality rate in sepsis group were significantly higher than the other groups ( P＜0. 05 ) , and no statistically significant differences between infection group and no-infection group ( P＜0. 05). The ALB level in survived infants [(29. 6±7. 5)g/L] was statistically higher than the deceased ones [(20. 4±6. 9)g/L](P＜0. 05). The incidence of critically ill newborns was 65. 5％ in ALB ＜25 g/L group, significantly higher than the other groups (P＜0. 05). 26. 2％ in ALB ＜25 g/L group had more than 4 organs injuries, significantly higher than ALB ＞30 g/L group ( P＜0. 05 ) . Conclusions Hypoalbuminemia is common among neonates with sepsis. The ALB level had predictive value for the prognosis of neonatal infection.

Objective To recheck the reliability of methotrexate ( MTX) serum concentration at 48 h ( C48 h ) in predicting the pharmacokinetic characteristics and toxic reactions at terminal elimination phase after high dose MTX infusion and to provide a reference for determination of rational rescue regimen in clinic practice. Methods In total,114 cases of children with acute lymphoblastic leukemia (ALL) received 176 courses of high dose MTX chemotherapy treatment. The regimen was continuous infusion of MTX[3 -5 g·( m2 ) -1 ] in 24 h. Plasma samples were treated with solid phase extraction and serum concentrations of MTX were determined by HPLC at 24,48 and 72 h (C24 h ,C48 h and C72 h ) after starting MTX infusion. All data were divided into C48 h≥1 μmol·L-1 group and C48 h<1 μmol·L-1 group. The pharmacokinetic parameters of the two groups at elimination phase were estimated by residual method and the toxic reactions after MTX infusion of two groups were compared by Ridit analysis. Results The C72 h and AUC48-∞ were significantly higher in C48 h ≥1 μmol · L-1 group than in C48 h <1 μmol·L-1 group (P<0. 01). The MTX toxicities to the blood,digestive and hepatic systems were significantly higher in C48 h≥1 μmol·L-1 group than in C48 h < 1 μmol · L-1 group ( P < 0. 05). Conclusion C48 h can predict the pharmacokinetic characteristics and toxic reactions at ther terminal elimination phase. Therefore,C48 h≥1 μmol·L-1 can be used as a marker of MTX elimination delay event to guide later rescue regimen.

Objective To understand the current situation about flexible position switch of non-licensed nurses in Chongqing, to discuss the cause of the flexible position switch, and to provide basic information for constructing scientific managerial measure. Methods Using the stratified clustering method to sample the nurses from 18 hospitals of different ranks in Chongqing and investigated them with self-designed questionnaire. Results Among the 1145 non- licensed nurses joining the investigation, 42.53%and 52.49% of them showed the will to switch their positions or occupations, 84.89% of them objected their children to occupy themselves with nursing service. 68.56% non-licensed nurses believed that flexible position switching had influence on themselves, while 74.50% of them believed that flexible position switching had impacts on hospitals. The main cause of the flexible position switching of non-licensed nurses included: feeling their work not beyond exceptions、 not enough respect in hospital 、lack of further development, and so on. Conclusions The high rate of will for flexible position switch cause great influences on the development of hospitals and non-licensed nurses themselves. Better treatment and raising respect should be given to them in order to stabilize nursing team.

Objective To investigate the effect of the application of tranexamic acid in unilateral total knee arthroplasty (TKA)with different methods .Methods Totally 120 cases of primary unilateral TKA patients admitted from June 2013 to May 2012 were studied ,including 33 males and 97 females ,with the average age of (65 ± 9) years (31 to 81 years) .Patients were divided into intravenous tranexamic acid group (group V ) ,topical tranexamic acid group (group T ) and irrigation using tranexamic acid group (group I) ,and control group (group C) .There were 30 cases in each group .Four groups of patients had no differences in age ,gender ,body mass index and disease diagnosis ,operative time ,preoperative hemoglobin ,preoperative hematocrit differences sta‐tistically(P>0 .05) .Postoperative blood loss and blood transfusion were observed .Groups were compared using one‐way ANOVA analysis .Results The total blood loss of group V was (368 ± 95)mL ,total blood loss of group T was (407 ± 118)mL ,both were less than the control group (509 ± 96)mL ,the difference was statistically significant (P<0 .05) .The differences between the blood loss of group I (491 ± 122) mL and the control group was not statistically significant (P=0 .924) .Group V showed the least a‐mount of hidden blood loss .Group T showed the least amount of visible blood loss .There were not deep vein thrombosis ,infections and other complications in any groups .Conclusion Intravenous and topical application of tranexamic acid can significantly reduce postoperative blood loss in TKA .Irrigation with tranexamic acid can not reduce the blood loss effectively .