Background and purpose:It is important to control acute pain after gynecological oncologic surgery effectively.This study was to compare the clinical effects of butorphanol and flurbiprofen axetil(FA) combined with sufentanil on patient controlled intravenous analgesia(PCIA) after surgery.Methods:Forty ASA Ⅰ-Ⅱ patients scheduled for elective gynecological oncologic surgery under general anesthesia were randomly divided into two groups of twenty each,butorphanol group(Group B) and flurbiprofen axetil(FA) combined with sufentanil group(Group FS).After induction Group B received a loading dose of butorphanol 1 mg,and Group FS received that of FA 50 mg.Before the operation was over,Group B received intravenous infusion of butorphanol 13 mg in 100 mL saline,whereas Group FS received that of FA 150 mg combined with sufentanil 200 ?g in 100 mL saline.In the postoperative period,visual analogue scale(VAS),Ramsay sedative scores and side effects were recorded at 6,12,24 and 48 h.Results:There were not any signifi cant differences in VAS and the demanding times for supplemental bolus between the two groups.All VAS were below 4.Ramsay sedative scores of Group B before 12 h were signifi cantly higher than those in group FS(P0.05).The incidence of nausea and vomiting in Group FS was signif icantly higher than that in Group B(P

The combination of Angelicae sinensis Radix (Danggui, DG) and Astragali Radix (Huangqi, HQ) is a popular herb pair commonly used in clinic for the treatment of blood deficiency syndrome in China. The aim of this paper is to study the interaction of DG and HQ nourishing and tonifying blood effects by response surface method. The blood deficiency mice were induced by injecting N-acetylphenylhydrazine (sc) and cyclophosphamide (ip). The blood deficiency mice were administrated intragastrically with DG-HQ extracts (0:1, 1: 5, 2:5, 2:3, 1:1, 3:2, 5:2, 5:1, 1:0). The changes of the peripheral blood indexes and organ indexes were observed. The indexes were integrated by comprehensive index method; the interactions of DG and HQ were analyzed by the response surface diagram established with Matlab software. The results showed that DG and HQ at most of their combination ratios had synergic effect. Within the range of 1:5 - 5:1, all of the extracts of DG-HQ showed synergic effect, and among which, high-doses had better effects than low-doses. The highest value (-1) of the synergic effect was showed when DG was 10 - 40 g at the same time of HQ as 90 -180 g, and DG was 50 - 100 g at the same time of HQ as 20 - 100 g. DG-HQ at all combination dosages within Chinese Pharmacopeia (DG: 6 - 12 g, HQ: 9 - 30 g) had certain synergic effect, and Danggui Buxue Decoction (DG: 6 g, HQ: 30 g) also was at this range. The results provided scientific basis to the clinical application of DG and HQ. And the response surface method was firstly applied to quantitatively evaluate the bio-activity change of herb combination, which provided a novel way for modern basic research on the interaction of herbs.

Objective: To investigate the etiology, clinical features, treatment and outcome of nephrotic syndrome associated with chronic mercury poisoning. Methods: From June 2013 to April 2018, Beijing Chaoyang Hospital, Capital Medical University received 33 patients with chronic mercury-neutral nephrotic syndrome. The clinical manifestations, laboratory tests, treatment methods, and outcomes were analyzed. Results: Among the 33 patients, 27 patients had mercury exposure due to daily-life contact and the other 6 patients were caused by iatrogenic mercury. The symptom was characterized by typical nephrotic syndrome such as lower extremity edema and proteinuria at first onset. The treatment was based on mercury-removing treatment, 19 cases were treated with mercury removal alone, 16 cases were completely relieved; 10 cases were treated with mercury removal and glucocorticoids, all of which were completely relieved; 4 cases were treated with mercury removal, glucocorticoids and immunosuppressive agents, all complete remission; clinical complete remission rate is about 90.9% (30 cases in total) . Urinary mercury levels decreased the fastest between the first and second courses of mercury treatment, but the total amount of urine protein increased. As the amount of urinary mercury excreted increased, the total amount of urine protein decreased gradually (Z=2.86, P<0.01) . Conclusion The clinical features of chronic mercury-induced nephrotic syndrome are non-specific, easy to be misdiagnosed and missed. The treatment is mainly treated with mercury removal treatment. The prognosis is good. In severe cases, glucocorticoid therapy can be supplemented.

To summarize the nursing care of a patient with acute myocardial infarction complicated with cardiogenic shock before operation.The main nursing points are as follows:in the acute stage,the integrated rescue was implemented with rapid on-machine coordination of external cardiopulmonary resuscitation,multidisciplinary collaboration to ensure safe patient transport;during the bridging period,the combined operation care of extracorporeal membrane oxygenation,intra-aortic balloon counter pulsation and continuous kidney replacement therapy was carried out with goal-oriented anticoagulation care,prevention of catheter-related infection with the assistance of mechanical circulation,and neurological function monitoring.The patient successfully passed the waiting period for heart transplantation and underwent heart transplantation 21 days after admission.With the follow-up for 1 year,the patient recovered well.

Objective To investigate the management of Graves' disease in Jiangsu province. Methods According to the 2011 management of GD survey from American Thyroid Association and the 2013 survey from European Thyroid Association, a questionnaire was designed for this survey to acquire the diagnosis, treatment, and follow-up of Graves' disease among endocrinologists from 35 tertiary hospitals in Jiangsu province. Results A total of 476 valid questionnaires were collected. For patients with symptoms of hyperthyroidism, a large majority of respondents monitored serum FT3 , FT4 , TSH, thyroid peroxidase antibody, thyroglobulin antibody, TSH receptor antibody, and finding of thyroid ultrasound, accounted for 95. 6％, 95. 0％, 95. 4％, 95. 8％, 90. 3％, 90. 5％, and 93. 9％physicians, respectively. 91.2％ of physicians preferred anti-thyroid drugs as the first-line treatment, and 92. 6％ of them gave priority to the use of methimazole. For the duration of anti-thyroid drugs therapy, 41.2％of endocrinologists chose 24 months, while 20％ chose 18 months. When patients have moderate and active ophthalmopathy, most respondents with medium or senior professional titles preferred anti-thyroid drugs, while most resident physicians chose radioactive iodine plus corticosteroids. When pregnancy was confirmed in the patients of Graves' disease, 88％ of respondents preferred propylthiouracil during the first trimester of pregnancy, and 58. 4％ of them would continue propylthiouracil into the second trimester. Conclusions The mastering of basic perception of Graves' disease knowledge is satisfactory among the endocrinologists. But by comparing to the American and European survey results and related guidelines, there are still some differences in diagnosis and treatment. Therefore, physicians should notice those differences and make improvement on standardized treatment for patients to raise the response ratio while reducing the recurrent events.

Objective To investigate the characteristics of lung function in the patients with asbestosis of different stages,and analyze the correlations between the puhnonary function values and imaging score of chest X-ray.Methods A cohort of newly diagnosed 249 asbestosis patients over a period of eight years in a single center were evaluated.Clinical data were colleeted from clinical charts.Radiographs were reviewed by the experts blinded to clinical data.The asbestosis patieuts were classified into Ⅰ to Ⅲ stages by chest X-ray according to the guideline.The correlations between the pulmonary function values and imaging score of chest Xray were aualyzed.Results The prevalence of stage Ⅰ to Ⅲ in this asbestosis cohort was 73.5％,19.3％ and 7.2％ respectively.With the stages iucreasing,the patients' forced vital capacity (FVC),total lung capacity (TLC),total carbon nonoxide diflitsion capacity (DLCO) predicted values were all reduced showing the restrictive ventilation impairment and/or gas exchange barrier.The obstruction of the small respiratory tracts was detected in the asbestosis of all the different stages.According to the small shadow density of each lung area,chest small shadow density score had a siguifieant negative correlation with FVC,TLC or DLCO predicted values respectively (all P＜O.01).Conclusion The patients with asbestosis of different stages had varying degrees of gas exchange impairment,small airway dysfunction with or without ventilation dysfunction.The decreasing of DLCO was earlier than lung volume change.Chest X-ray image score paralleled the decline of lung function values,reflecting the severity of the disease.

Objective To investigate the characteristics of lung function in the patients with asbestosis of different stages,and analyze the correlations between the puhnonary function values and imaging score of chest X-ray.Methods A cohort of newly diagnosed 249 asbestosis patients over a period of eight years in a single center were evaluated.Clinical data were colleeted from clinical charts.Radiographs were reviewed by the experts blinded to clinical data.The asbestosis patieuts were classified into Ⅰ to Ⅲ stages by chest X-ray according to the guideline.The correlations between the pulmonary function values and imaging score of chest Xray were aualyzed.Results The prevalence of stage Ⅰ to Ⅲ in this asbestosis cohort was 73.5％,19.3％ and 7.2％ respectively.With the stages iucreasing,the patients' forced vital capacity (FVC),total lung capacity (TLC),total carbon nonoxide diflitsion capacity (DLCO) predicted values were all reduced showing the restrictive ventilation impairment and/or gas exchange barrier.The obstruction of the small respiratory tracts was detected in the asbestosis of all the different stages.According to the small shadow density of each lung area,chest small shadow density score had a siguifieant negative correlation with FVC,TLC or DLCO predicted values respectively (all P＜O.01).Conclusion The patients with asbestosis of different stages had varying degrees of gas exchange impairment,small airway dysfunction with or without ventilation dysfunction.The decreasing of DLCO was earlier than lung volume change.Chest X-ray image score paralleled the decline of lung function values,reflecting the severity of the disease.