Objective To explore the efficacy and safety of low-dose ketamine for prevention of shivering during cesarean section under subarachnoid space and epidural anesthesia.Methods Ninety pregnant women who scheduled cesarean delivery under subarachnoid space and epidural anesthesia were randomized divided into three groups:control group (30 patients) low-dose ketamine group (30 patients) and high-dose ketamine group (30 patients).0.9％ sodium chloride,0.25 mg/kg(3 ml),and 0.50 mg/kg (3 ml) ketamine were given in three groups before operation.The incidence of shivering and adverse effect were recorded respectively before anesthesia,after anesthesia 15 min and 30 min and after operation 1 h.Results The level of mean arterial pressure (MAP) in control group after anesthesia 15 main and 30 min and after operation 1 h[(62 ± 10),(58 ± 8),(61 ± 11) mm Hg(1 mm Hg =0.133 kPa)] were significantly lower than those in high-dose ketamine group [(78 ± 12),(82 ± 8),(76 ± 11)mm Hg] and low-dose ketamine group [(72 ± 10),(76 ± 6),(80 ± 7) mm Hg],there was significant difference (P ＜ 0.05).There was no shivering need treat in low-dose ketamine group and high-dose ketamine group.The rate of hallucinations and nystagmus in low-dose ketamine group [0,6.7％ (2/30)] was significantly lower than that in high-dose ketamine group [20.0％ (6/30),50.0％ (15/30)],there was significant difference (P ＜ 0.05).Conclusion The pretreatment with low-dose ketamine on shivering during cesarean section under subarachnoid space and epidural anesthesia has better preventive effectiveness,0.25 mg/kg of ketamine is more effective than 0.50mg/kg.

BACKGROUND:At present, a great quantity of research has shown the effectiveness of traditional Chinese medicine and bone marrow mesenchymal stem cel s for vascular restenosis. However, studies concerning their combined application to restenosis after percutaneous transluminal angioplasty with diabetes mel itus are presently lacking.
OBJECTIVE:To observe the effects of combined application of bone marrow mesenchymal stem cel s and benefiting-Qi nourishing-Yin and dissolving-congestion prescription on restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus.
METHODS:A dog model of vascular restenosis with diabetes mel itus was established by bal oon injury of femoral artery and intravenous injection of al oxan. After successful model induction, 22 dog models were randomly divided into three groups:model group (n=6), treatment with Chinese medicine (n=8), and combined treatment with bone marrow mesenchymal stem cel s and Chinese medicine (n=8). Serum vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay preoperatively and at 1, 2, 4 and 8 weeks postoperation. Samples of vessels were taken to conduct pathomorphological observation and quantitative analysis of proliferation degree. Tissues, including heart, liver, kidney and pancreatic gland, were col ected to evaluate the safety of stem cel transplantation using hematoxylin-eosin staining at 8 weeks postoperation.
RESULTS AND CONCLUSION:Serum vascular endothelial growth factor levels began to increase at 1 week postoperation in the Chinese medicine group and combined treatment group, at 4 weeks postoperation in the model group compared with preoperation (P<0.05). At al time points, serum vascular endothelial growth factor levels were highest in the combined treatment group, but lowest in the model group (P<0.05). Quantitative analysis of vascular proliferation demonstrated that at 8 weeks postoperation, new intimal area, new intimal/medial areas and stenosis rate were highest in the model group, but lowest in the combined treatment group at 8 weeks postoperation (P<0.05). Safety assessment of stem cel transplantation showed morphological structures of the heart, liver, kidneys and pancreas were normal, no necrosis. In a word, the effects of the combined application of bone marrow mesenchymal stem cel s and benefiting-Qi nourishing-Yin and dissolving-congestion prescription were much pronounced in preventing restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus rather than single therapy of Chinese medicine. It is a safe and effective treatment to prevent vascular restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus.

BACKGROUND:Previous tudies have shown that the anti-aging effects of stem cel s with lycopene are more significant, and can also significantly improve the aging body immune function.
OBJECTIVE:To investigate the anti-aging effects of human umbilical cord mesenchymal stem cel s combined with lycopene on the aging beagles.
METHODS:Sixteen aging beagles (6-7 years old) were randomly divided into two groups:aging control group and aging treatment group;young beagles (3-4 years old) were chosen as young control group. In the aging treatment group, human umbilical cord mesenchymal stem cel s combined with lycopene was given;while in the other two group, an equal amount of DMEM/F12 cel culture medium and sunflower oil was given. Each dog's general conditions were observed regularly during the whole progress. The changes of superoxide dismutase,
malondialdehyde, glutathione peroxidase in the serum were detected at regular time of the whole process, and the structure changes of each organ were observed at 24 weeks of treatment.
RESULTS AND CONCLUSION:(1) Before treatment, the levels of superoxide dismutase and glutathione peroxidase in the aging control and treatment groups were lower than those in the young control group (P<0.05), while the malondialdehyde content was higher than that in the young control group (P<0.05). However, there was no significant statistical difference between aging control and treatment groups (P>0.05). (2) For the aging treatment group at 24 weeks of treatment:the beagle fur became clearer and smoother, motility was strengthened, appetite became better;and the activity of superoxide dismutase in serum at 8 to 24 weeks of treatment increased significantly compared with before treatment (P<0.05), the activity of glutathione peroxidase significantly increased from 6 weeks (compared with treatment before, P<0.05), the malondialdehyde content decreased significantly from 4 weeks of treatment to the completion of the experiment (compared with before treatment, P<0.05). (3) After the experiment, the microscopic observation showed that compared with the aging control group, the tissues and organ structures of the aging treatment group were al clear, had no inflammatory infiltrates, no obvious necrosis and fibrosis lesions. These results were mainly consistent with the observations of young control group. The above results show that umbilical cord mesenchymal stem cel s combined with lycopene therapy on the natural aging beagles may enhance the activities of antioxidant enzymes, reduce malondialdehyde content, and their combination also can repair tissue structures and promote the functions, which has obvious anti-aging effects.

Objective To investigate the effect of Sirt1 gene knockout on chronic kidney disease induced by 5/6 nephrectomy in mice and vascular endothelial growth factor (VEGF)/fetal liver kinase-1 (Flk-1) signaling pathway.Methods Twenty four male Sirt1 +/+ and Sirt1 +/-mice wererandomly divided into four groups:Sirt1+/+ mice with sham-operation (WT-Sham,n=6),Sirt1+/-mice with sham-operation (KO-Sham,n=6),Sirt1 +/+ mice with 5/6 nephrectomy (WT-Nx,n=6) and Sirt1 +/-mice with 5/6 nephrectomy (KO-Nx,n=6).Proteinuria was determined by urine collection from 8:00 to 8:00 the next day at 20 weeks.Serum creatinine (Scr),urea nitrogen (BUN) and the renal pathological changes were measured after 20 weeks.Expressions of Sirt1,collagen Ⅰ and transforming growth factor β(TGF-β) were used to analyze the changes of renal fibrosis by immunohistochemistry staining.Real-time PCR and Western blotting were used to measure the mRNA and protein expressions of Sirt1,fibronectin,collagen Ⅰ,VEGF and Flk-1 in kidney.Results Sirt1 expressed in glomernlar endothelial cells,podocytes,mesangial cells and renal tubular epithelial cells in Sirt1 +/+ mice,while Sirt1 expression intensity was significantly reduced in Sirt1 +/-mice.Compared with the WT-Sham group,WT-Nx group had increased proteinuria,BUN,Scr,glomernlar sclerosis index and tubulointerstitial fibrosis index at 12 weeks after operation (all P ＜ 0.01),and KO-Nx group had exacerbated the above up-regulations (all P ＜ 0.01).Compared with those in WT-Sham group,the expressions of fibronectin,collagen Ⅰ and TGF-β were up-regulated in WT-Nx group (all P ＜ 0.01),and were significantly augmented in KO-Nx group (all P ＜ 0.01).Compared with those in WT-Sham group,renal mRNA and protein expressions of VEGF and Flk-1 were decreased in WT-Nx group,and KO-Nx group aggravated their down-regulation (all P ＜ 0.01).Conclusions Sirt1 gene knockout can increase proteinuria and Scr,and aggravate renal pathology and renal fibrosis in 5/6 nephrectomized mice,which is associated with the inhibition of VEGF/Flk-1 signaling pathway.It is suggested that Sirt1 may be a potential therapeutic target of chronic kidney disease.

Objective To compare the genotype distribution of HPV in cervical cells of natural crowd and tissues of cervical in‐traepithelial neoplasia(CINⅢ grade) and cervical carcinomas patients .Methods PCR and gene‐chip technology were utilized for the genotype detection of 23 kinds of HPV in cell specimens from 1 047 women of natural crowd (normal group) and tissue specimens from 173 cases of cervical intraepithelial neoplasia(precancerosis group) and 133 cases of patients with cervical carcinoma (cervical carcinoma group) .Results There were 109 ,159 and 121 cases of HPV positive specimens respectively in normal group ,precancer‐osis group and cervical carcinoma group ,and the HPV infection rates were 10 .41% (109/1 047) ,91 .91% (159/173) and 90 .98%(121/133) ,respectively .Conclusion PCR and gene‐chip technology can be used to detect HPV genotypes in cervical cells and cer‐vical tissues specimens .

Objective To determine the impact of uric acid changes on kidney function in middle-aged and elderly women with normal renal function.Methods Serum uric acid and estimated glomerular filtration rate(eGFR) were studied by prospective cohort analysis in 1152 middle-aged and elderly Dalian women with serum uric acid<7 mg/dl, estimated glomerular filtration rate(eGFR)≥90 ml·min-1·(1.73 m2)-1, and age>45 years old.Results The analysis of variance (ANOVA) of clinical indices between baseline and follow-up data showed that an eGFR was decreased after three years in both middle-aged and elderly women even with normal serum uric acid.Compared with those in the lowest guartile subgroup, a significant drop of eGFR to less than 90 ml·min-1·(1.73 m2)-1 was seen in those with the highest guartile of baseline serum uric acid group (OR=1.707, 95%CI 1.192-2.443, P=0.003).Furthermore, there were positive correlations between changes in the levels of serum uric acid and eGFR, and linear regression analysis showed that, as the change level of serum uric acid increased, the change level of eGFR declined(β=1.562, 95%CI 1.050-2.075, P<0.01], and the changing degree of uric acid increase is independent risk factors refor eGFR reductions.Conclusion Reduction in eGFR level is inversely related to serum uric acid in perimenopausal and postmenopausal women.However, our study showed that, women with serum uric acid level ranging from normal, slight increase, and relatively high levels, the increasing degrees of uric acid are independent risk factors responsible for the changing degree of eGFR reduction.

This paper analyzed the foreign measurement and evaluation system of physician professionalism,from the perspectives of the evaluation of occupation behavior,the multi sources of evaluation,the evaluation of empathy,and the cross-cultural background.It also discussed the basic condition of the development of domestic evaluation and evaluation system,and analyzed it from the diversity and comprehensiveness of evaluation perspectives,the specific and objectivity of evaluation items,the clarity and quantitative feature of evaluation indexes,as well as the openness and feedback of evaluation system.In addition,this paper reviewed the domestic and foreign measurement and evaluation methods of physician professionalism in recent years and pointed out that the construction of good measurement and evaluation system is the only way to deepen the research of physician professionalism.

Objective To explore current status and influencing factors of nurse career attitude in one primary hospital in Chongqing. Methods By nurse career attitude scale made by Nursing School of the Second Military Medical University, a total of 213 nurses had been chosen and investigated by stratified sampling method from our hospital. The result of investigation had been analyzed by descriptive statistics analysis method, single factor analysis of variance and multiple liner regression analysis. Results The total career attitude score of nurse in primary hospital acquired 2. 01 ~ 8. 36, average score was (4. 33 ± 0. 88) . In thirty clauses, the most people chose long-term three shifts work arranged by manager, harmful personal health education, impacting on family life occupying 75. 59% (161 / 213). By single factor analysis of variance, it showed different level of career attitude that nurses were in different gender, educational level, occupational title, income level and three shifts (F = 11. 35,8. 30,3. 16,8. 44,3. 53, respectively; P < 0. 05). The result of multiple liner regression analysis indicated that nurses had more positive attitudes with male, high education, high occupational title, high income, less three shifts comparing with others (P < 0. 05). Conclusions Both internal and external causes working together formed positive career attitudes of nurses in primary hospital. The administrative department should establish a harmonious environment, guide nurses correctly, and inspire them by career education.

Objective To discuss the case management of pain in patients with tibial plateau fractures. Methods Chose a total of 60 patients with fracture of tibial plateau during January to December 2013 in our hospital as the research objects, all patients had fresh fractures and accepted fracture reduction with plate fixation. According to random number table method, selected patients divided into observation group and control group, 30 cases each of group. Pain in the control group accepted routine treatment and postoperative nursing, while patients of the observation group underwent step-by-step implementation of case management based on the the intervention of control group:assessed the level of pain, patient′s perception of pain and satisfaction of pain control when patients admitted, 1 h before operation, came back unit, 24 h, 48 h, 72 h after operation. Results After nursing intervention, the score of pain assessment were (3. 21 ± 1. 89), (2. 85 ± 1. 85), (1. 85 ± 1. 78) in the observation group apparently lower than (4. 42 ± 2. 15), (3. 88 ± 2. 03), (2. 67 ± 2. 31) of control group (t=3. 265, 2. 896, 2. 798; P<0. 05); the recognition of pain among patients of observation group improved dramatically (P<0. 05); in the observation group, the patients acquired (14. 68 ± 3. 24), (4. 69 ± 1. 57), (4. 62 ± 3. 28), (1. 69 ± 0. 87) for the total sensation and affection scores of pain control, VAS score and PPI score better than (22. 43 ± 5. 36), (8. 45 ± 2. 54), (6. 49 ± 2. 65), (3. 66 ± 1. 25) of control group (t =8. 365, 6. 154, 5. 126, 7. 458; P <0. 01). Conclusions Case management nursing intervention can significantly reduce the level of pain in patients with fracture of tibial plateau, increase awareness of pain and patient′s satisfaction to pain control.

Objective To investigate the prevalence of vitiligo in China through a multi-center and larse-population epidemiological survey.Methods A community-based survey was conducted in 6 cities from 6 provinces.Cluster sampling method was used.Subjects were required to fulfill the self-report questionnaires and received physical examination by dermatologists.EpiData and SPSS11.5 were utilized for statistical analysis. Results Totally,19 974 patients participated in this study,and 17 345 valid questionnaires were retrieved with a return rate of 86.84%.Of them,122 were found to have vitiligo.The prevalence and standardized prevalence of vitiligo was 0.70% and 0.56% in all patients,0.95% (75) and 0.69% in male patients and 0.50% (47) and O.45% in female patients.respectively.A significant elevation was observed in the prevalence of vitiligo in males than in females (P<0.01).The prevalence of vitiligo was increased with age and peaked in patients aging from 60 to 69 years and those over 70 years.The age at onset of vitiligo varied from 0 to 19 years in 21.85% of these patients,from 20 to 49 years in 47.05%.The most connnon type was focal vitiligo,which accounted for 36.06%,while the rarest type wag segmental type (2.46%).The pesitivity rate of family history of vitiligo was 9.84% in patients and 1.31% in community population (P<0.01).About 31.97% of the patients complained of negative influence of vitiligo on quality of life.Conclusions The standardized prevalence of vitiligo is 0.56%in 6 provinces from China.Males seem to have a higher prevalence of vifiligo than females.