The two pore domain K + Channel is a new superfamily of potassium channel subunits expressing the background potassium current on the cell membrane. Its functions are closely related with the physiological and pathological changes. This article reviews five groups of the two pore domain K + Channel on the gene and protein structure, current characteristics and pharmacological properties.

Objective To evaluate the efficacy and safety of morphine by supersound atomizer for the management of postoperative pain in gynecology and obstetrics patients.Methods Eighty ASA class III patients scheduled for elective mixed gynecology and obstetrics surgeries were randomly and single-blindly located into 4 groups.Patients in each group received different analgesia therapy 30 rain before the end of the surgeries,as inhaling morphine 15 nag in group MI,inhaling morphine 20 nag in group M2,inhaling normal saline 10 ml in group N and intravenous patient-controlled analgesia (PCA) in group PCA.Open-label rescue analgesia of intramuscular injection pethidine 50 mg or intravenous PCA was also available as needed.Pain scores were measured at baseline,15 min,30 min,1 h,2 h,3 h,4 h,6 h,8 h and 24 h after the extubation using visual analng score ( VAS ),vital signs,adverse events,and the uses of rescue analgesia were also recorded.Results The VAS of group M2 were significantly lower than that of group N and group M1.The VAS at 15 min,1 h,6 h,8 h,24 h of group M2 were significantly lower than that of group PCA(P ＜ 0.05 or ＜0.01 ).The VAS at 15 min,30 min,1 h,2 h,4 h,6 h of group M1 were significantly lower than that of group N (P ＜ 0.05 or ＜ 0.01 ) postoperatively,which were significantly higher than that of group PCA except for 30 min.The morbidity of postoperative,nausea and vomiting in group M1 and group M2 were significantly higher than those in group N and group PCA.The rescue analgesia was more performed in group M 1 and group N than that in group M2 and group PCA.Conelusions Inhalation of morphine by supersound atomizer via intratracheal tube may produce safe and satisfying analgesic effect in postoperative pain model of gynecology and obstetrics patients.More studies are needed to determine what,if any,the optimum dose of morphine is for postoperative pain relieving and the possible mechanism.

OBJECTIVE:To provide reference for safe application of antibiotic drugs in single or inter-medical institution ser-vices. METHODS:An antibiotic drug safety evaluation index system was established by reference to literatures. Medical records tracing method was adopted to obtain the medical records of children with respiratory infectious diseases under the medical consor-tium model. The medical records were matched and evaluated by experts to analysis the safety of antibiotic drug use in single medi-cal institution and the connection between two medical institutions with respect to the safety of antibiotic drug use. RESULTS:248 effective medical records had been obtained. Under the medical consortium model,the rate of the combination of antibiotic drugs in large hospitals was 86.29%,higher than the community hospitals of 77.02%(χ2=5.49,P<0.05). The error rate of antibiotic drug use by children in large hospitals was 14.52%,lower than the community hospitals of 25.81%(χ2=9.733,P<0.05). There were many contradictions in antibiotic drug use between the medical institution where children received treatment initially and the medi-cal institution which the children were referred to and hospitalized in. There were totally 128 cases of unsafe antibiotic drug use, with the overall incidence of 51.61%. CONCLUSIONS:Under the medical consortium model,the safety of antibiotic drug use by the hospitalized children in single medical institution is worrying,and the connection between two medical institutions with respect to the safety of antibiotic drug use by children who are referred and hospitalized is less reliable.

In order to improve the clinical outcomes and promote the development of enhanced recovery after surgery(ERAS),a full-time specialized role of nurse navigator(NN) was established in Department of Surgery in February,2016. Clinical pathway for ERAS was designed,and role functions,core competencies and responsibilities of NN were formulated. According to the functions and the working frame,NN connected and coordinated teamwork activities,monitored the implementation of ERAS during the overall process. After implementation,the NN had dealt with 10 unusual incidents,the execution efficiency of the 14(82.4%) measurements were 100%,1 measurement was 97%,2 measurements were 94.1%,and 33 patients and 42 medical staff thought highly of the NN. This practice effectively promoted the development of ERAS team and specialist nurse role in our hospital.

Objective To explore the application of nutritional management leaded by nurses in hospitalized phthisical patients.Methods We set up a safe,effective nutritional management model by establishing united nutritional management group,making nutritional management system and process and organizing nutritional management knowledge training,and this model was carried out in 50 hospitalized phthisical patients.Results The total satisfaction rate for nutritional management was 97.56％.The screening risk rate for nutrition by nurses was 100％.Dietitians were asked to assess 22 cases for nutrition risk and 12 cases received nutritional support.The supporting rate was 54.55％,and the patients' condition was improved.Conclusion The application of the nutrition management leaded by nurses in hospitalized phthisical patients improved patients' nutritional condition,increased satisfaction of patients,enforced the screening function of nurses during the process of nutrition management and promoted the process of nursing expertise.

Objective To explore the image quality and radiation dose for coronary angiography using DSCT (dual-source computed tomography) under lower tube voltage and lower contrast agent concentration ('double low').Methods A total of 160 patients with suspected coronary artery disease underwent dual-source CCTA.80 patients (BMI ＜ 25 kg/m2) were randomly assigned to group A (270 mg I/ml-80 kV) and B (350 mg I/ml-120 kV).The other 80 patients (25 ≤ BMI ＜30 kg/m2) were randomly assigned to group C (270 mg I/ml-100 kV) and D (350 mg I/ml-120 kV),sonogram affirmed iterative reconstruction technology and 270 mg I/ml contrast agent were applied to group A and C ; FBP technology and 350 mg I/ml contrast agent were applied to group B and D.Adaptive cardio-sequence prospective ECG-gated technology was applied in all patients,while the acquisition phase was 65％-75％ RR interval (when heart rate ＜ 75 beats / min) or 40％-50％ RR interval at when heart rate ≥ 75 beats/min.Volume CT dose index (CTDIvol),dose length product (DLP),effective dose (E),size specific dose estimates (SSDE),image noise,CT value,signal-to-noise ratio (SNR),and contrast-to-noise ratio(CNR) were all evaluated for each patient.Results There was not statistical difference in scan length among groups A and B,C and D.There was statistical difference in tube current between group A and B (t =8.932,P ＜0.05).There was not statistical difference in tube current between group C and D (tCD =-1.212,P ＞ 0.05).There was statistical difference in CTDIvol,DLP,E and SSDE between group A and B,C and D (tCTDIvol =-16.141,-11.440 ; tDLP =-17.454,-10.521 ; t =-17.444,-10.523 ;tSSDE =-13.032,-9.119,P ＜0.05).Compared to group B,the SSDE in group A decreased by 64.4％.Compared to group D,the SSDE in group C decreased by 39.3％.There was no statistical difference in image noise between group A and B,C and D (P ＞ 0.05).There was statistical difference in CT value,SNR and CNR between group A and B (t =0.436,4.623,3.272,P ＜ 0.05).There was no statistical difference in CT value and CNR between group C and D,while there was statistical difference in SNR between group C and D (t =2.981,P ＜0.05).There was no statistical difference in image quality scores between group A and B,C and D (P ＞ 0.05).Conclusion Compared with conventional DSCT coronary angiography,'double low' DSCT coronary scanning solution can significantly reduce the radiation dose and contrast agent,and could provide the effective coronary images which meet the clinical diagnostic needs.

Objective A retrospective review of the use of delayed sterna closure (DSC) after pediatric cardiac operations.The purpose of this study is to access the morbidity of DSC and to analyze the risk factors that may predict the need for DSC.Methods Between January 2008 and December 2011,5 546 infants (2 843 males,2 703 females) underwent cardiac operations through midterm sternotomy in Shanghai Children' s Medical Center.Median age was 5 months(1 day to 11 months) and mean weight was 6.1 kg(2.0-12.5 kg).The pathologies included transposition of great artery(TGA),corctation of aorta (CoA),interruption of aortic arch (IAA),pulmonary atresia (PA),truncus arteriosus (Truncus),complete atrioventricular septal defect(CAVSD),total anormalous pulmonary vein connection (TAPVC),double outlet of right ventricle(DORV),tetralogy of Fallot(TOF),and ventricular septal defect(VSD),et al.All hospital records were reviewed and clinical data were studied and analyzed.Results A total of 313 patients had DSC (5.6％).There were 191 males and 122 females.The reasons for DSC are hemodynamic instability in 296,bleeding in 11,and ECMO(or VAD) in 6 patients.Two hundred and fiftyone (80.2％) patients were less than 5 kg,84 (26.8 ％) patients were neonates,and 125 (39.9％) patients aged between one and three months old.The incidences of DSC for these patients were 13.9％,34.4％,and 18.4％ respectively.The diagnosis of complex congenital heart defects had a high risk of DSC.The incidences of DSC for TGA,CoA,IAA,PA,Truncus,CAVSD,TAPVC,and DORV were 28.8％,17.8％,43.1％,9.0％,30.4％,6.5％,and 10.8％ respectively.The DSC patients had longer duration of CPB time(147 min versus 72 min) and clamping time(81 min versus 40 min).In 282 patients the sternums were closed 1-11 days after the initial operation.In 3 cases the trial of closure failed for the first time and succeeded a second time until several days later.Fouty-six patients died ultimately including 15 patients died after the closure of sternum with a total mortality of 14.7 ％.Surgical site infection occurred in 17 patients (5.4％),and surgical intervention were needed in 4 severe cases(1.3％).Conclusion Neonates,an age less than 3 months,weight less than 5 kg,long CPB time and clamping time,and the diagnosis of complex congenital heart defects were risk factors of the need for delayed sterna closure after pediatric cardiac operations.

Bevacizumab has been widely used in tumor targeting therapy,while the most common adverse reaction is renal impairment,manifested as proteinuria. The main mechanisms may include interfering podocytes-endothelial vascular endothelial growth factor(VEGF)axis signals,increasing glomerular pressure caused by secondary hypertension,subacute renal thrombotic microangiopathy caused by endothelial damage and so on. Thrombotic microangiopathy is the main renal pathological type,and other rare types include glomer-ular lesions,renal interstitial disease,and benign renal arteriolar nephrosclerosis. Therefore,urine protein excretion and renal function should be closely monitored during bevacizumab treatment period for timely treat-ment,dose reduction or even withdrawal if necessary to ensure renal function.

AIM:To investigate the expressions of methylthioadenosine phosphorylase(MTAP)and ornithine decarboxylase(ODC)in human ovarian cancer.METHODS:60 fresh samples of ovarian cancer were collected.The expressions of MTAP mRNA and protein were analyzed by using RT-PCR and Western blotting,respectively.ODC activity was measured by high performance liquid chromatography.RESULTS:The expression levels of MTAP mRNA and protein in ovarian cancer were lower than those of control.In 9 of the 60 samples(15%)there were absence of detectable MTAP mRNA and protein.No significant relevance was found between the expression of MTAP and clinical pathologic features.ODC activity in ovarian cancer was(3.82?1.03)U,which was higher than that of normal ovarian tissues(1.38?0.59)U.ODC activity was related with tumor grade.In MTAP-deficiency ovarian cancer tissues ODC activity was significantly increased when compared with that of MTAP-expressing ovarian cancer samples.CONCLUSION:Down-regulated MTAP expression and up-regulated ODC activity really exist in ovarian cancer.Activation of ODC resulting from MTAP deletion may be one of the pathogenetic factors of ovarian cancer.

OBJECTIVE:To provide reference for rational use of antidepressive drugs. METHODS:In retrospective study,the utilization of antidepressive drugs in 31 hospitals of Nanjing area during 2013-2015 was analyzed statistically in respects of consump-tion sum,DDDs,DDC,B/A,etc. RESULTS:There were a total of 20 kinds of antidepressive drugs in 31 hospitals of Nanjing ar-ea,and total consumption sum increased year by year,increasing from 76 085 200 yuan in 2013 to 100 812 500 yuan in 2015,in-creased by 17.43% compared to 2014 and by 12.83% compared to 2015. The top 4 drugs in the list of consumption sum and DDDs were paroxetine,escitalopram,sertraline and venlafaxine. The sum of their consumption sum accounted for more than 60% of total consumption sum. The consumption sum of plant antidepressive drugs increased rapidly. B/A and DDC of antidepressive drugs kept sta-ble each year compared to last year,among which DDC of doxepin,clomipramine and amitriptyline was less than 2 yuan,B/A val-ues of sertraline,fluvoxamine,flupentixol and melitracen,doxepin,clomipramine and amitriptyline were all more than 1.00. CON-CLUSIONS:Of antidepressive drugs in 31 hospitals of Nanjing area during 2013-2015,selective serotonin reuptake inhibitors and se-lective serotonin-norepinephrine reuptake inhibitors took up dominant place,and plant antidepressive drugs is promising in the future.