ObjectiveTo investigate the feasibility and clinical effect of bispectral index (BIS) monitoring target controlled infusion of midazolam and propofol for sedation of mechanically ventilated patients.MethodsEighty cases with severe respiratory failure,sane,the need for endotracheal intubation mechanical ventilation for at least 24 h were divided into 4 groups by random digits table with 20 cases each.Group A and group C patients routinely received propofol and midazolam,group B and group D patients used BIS monitoring target controlled infusion of propofol and midazolam.The correlation of BIS and Ramsay score was analyzed,and the changes of mean arterial pressure (MAP) and heart rate (HR) were compared among 4 groups.ResultsBIS was negatively correlated with Ramsay score in group B and group D (P ＜ 0.05).MAP after 24 h intubation was lower than that at intubation immediately among 4 groups [group A:(63.89 ±4.68) mm Hg (1 mm Hg =0.133 kPa) vs.(92.33 ±3.57) mm Hg,group B:(62.66 ±3.97) mm Hg vs.(93.76 ± 4.02) mm Hg,group C:(64.59 ± 3.29) mm Hg vs. (93.78 ± 4.61 ) mm Hg,group D:(63.18 ±2.51 )mm Hg vs. (93.61 ± 5.36) mm Hg],and there were significant differences (P＜ 0.05).Group A and group B reached the standard after 1 h intubation.HR after 24 h intubation decreased in 4 groups,but there was no significant difference (P ＞ 0.05).ConclusionsBIS monitoring target conmolled infusion of midazolam and propofol for sedation of mechanically ventilated patients can achieve similar sedative effects,in addition,the need for rapid sedation of mechanically ventilated patients with suitable choice of propofol.At the same time,BIS is negatively correlated with Ramsay score.

Objective To describe the status of adherence to antiretroviral therapy (ART) in low endemic area,and to explore the factors affecting ART adherence so as to provide evidence for behavior management program.Methods A cross-sectional study was conducted in 53 patients receiving free ART in Chuanying and Yongji of Jilin Province.Structured face-to-face interview was carried out to determine sociodemographic characteristics,medical treatment information,medication adherence behaviors,health belief and self-efficacy,doctor-patient relationships and health service information.Results Among 53 patients,3 reported drug discontinuance.Of the other 50 patients,41 (82.0％) obeyed the request of the doctors (to be defined as adherence).All the participants had high levels of perceived benefits of adherence,perceived severity of non-adherence and self-efficacy.94.3％ of them reported using medication reminders,88.7％ reported receiving directly observed therapy (DOT),and 73.6％ reported falling into the habit of drug administration.Conclusions HIV/AIDS patients show relatively good adherence to medical treatment.Local comprehensive education and supportive programs may contribute to patients' good adherence to ART.

Objective To study the chemical constituents of Dioscorea septemloba.Methods The compounds were isolated by GC-MS and chromatography on silica gel column and identified on the basis of physico-chemical constants and spectral analysis.Results Thirteen compounds were isolated and their structures were identified as 4,8-dimethyl-1,7-nonadiene(Ⅰ),5-isopropyl-2,8-dimethylcyclodeca(Ⅱ),3,7-dimethyl-6-octen-1-ol-formate(Ⅲ),dodecanoic acid methyl easter(Ⅳ),N,N'-dinitro-1,2 cyclohexanddiamine(Ⅴ),1-octyn-4-ol(Ⅵ),?-sitosterol(Ⅶ),palmitic acid(Ⅷ),stigmasterol(Ⅸ),6,7-dihydroxy-2-methoxy-1,4-phenanthrenedione(Ⅹ),diosgenin(Ⅺ),ruscogenin(ⅩⅡ),and stigmasterol-3-O-?-D-glucoside(ⅩⅢ).Conclusion Compounds Ⅰ—Ⅵ,Ⅸ,Ⅹ,ⅩⅡ,and ⅩⅢ are obtained from this plant for the first time.

AIM: To evaluation the effects of esketamine and butorphanol on postoperative pruritus induced by epidural morphine injection in cesarean delivery parturients. METHODS: A total of 162 parturients who underwent elective cesarean section under continuous epidural anesthesia in Taizhou Central Hospital (Taizhou University Hospital), were selected and randomly divided into esketamine group (group K), butorphanol group (group B) and blank control group (group C). 5min after umbilicus amputation, parturients in group K was injected with 3 mg morphine diluent through epidural catheter, and esketamine 0.2 mg/kg intravenously. Parturients in groups B and C were given the same dose of morphine,and butorphanol 10 μg/kg or the same volume of normal saline, respectively. The incidence of postoperative pruritus at different times, the degree of pruritus and incidence of other adverse reactions were compared among three groups. RESULTS: The highest incidence of pruritus occurred within 4 hours after operation. The incidence of postoperative pruritus at 4 hours in group K and B was significantly lower than that in group C (3.7% vs. 3.7% vs. 29.6%, P < 0.05), the total incidence of postoperative pruritus within 48 hours was also significantly lower than that in group C (13.0% vs. 11.1% vs. 40.7%, P < 0.05), and the incidence of moderate to severe pruritus was also significantly lower than that of group C (5.6% vs. 3.7% vs. 31.5%, P < 0.05). There was no significant difference between group K and group B (all P > 0.05). There were no significant differences in the incidence of postoperative nausea, vomiting, dizziness and postoperative pain scores among three groups (P > 0.05). CONCLUSION: Both esketamine and butorphanol can reduce the incidence and degree of pruritus caused by epidural morphine injection in parturients, without affecting the analgesic effect of morphine and without increasing the incidence of adverse reactions. Esketamine is as effective and safe as butorphanol in preventing pruritus after cesarean section.