Objective To compare the effects of Dexmedetomidine and Midazolam for sedation in elderly patient with upper cervical spine fracture in awake tracheal intubation.Methods A total of 68 patients with upper cervical spine fracture undergoing awake tracheal intubation who treated in our hospital from Jan.2010 to Jan.2015 were considered as the objects,who was randomly divided into group A and group B.34 cases in group A were treated with Dexmedetomidine for sedation,and the other 34 cases in group B were treated with Midazolam for sedation.The Heart rate (HR),mean arterial pressure (MAP) and BIS value on the before anesthesia (T1),immediately before intubation (T2),immediately after intubation (T3),PaCO2 in before and after intubation,and the adverse reactions were compared between the two groups.Results There was no difference in HR,MAP and BIS at time of T1 between the two groups (P＞0.05).The HR,MAP and BIS were lower in group A than in group B at time of T2 and T3 (P＜0.01).The PaCO2 had no difference between the two groups at before and after intubation (P＞ 0.05).The rate of adverse effects had no difference between the two groups (x2 =1.308,P =0.253).Conclusions Compared with Midazolam,Dexmedetomidine can stable HR,MAP and BIS effectively and has a good safety in the treatment of elderly upper cervical spine fracture in awake tracheal intubation,which is worthy of clinical application.

Objective To investigate the effects of pretreatment with different concentrations of sufentanil of ketamine on the differentiation of human helper T cells in vitro. Methods Twenty-two healthy volunteers (11 males, 11 females) aged 20-45 yrs were enrolled in this study. In each volunteer 20 ml of blood was taken from peripheral vein and divided into 7 groups: control group (0.9% NaCl), 3 sufentanil groups (0.05, 0.5, 5.0 ng?ml-1) and 3 ketamine groups (100, 500, 2 500 ng?ml-1) .Whole blood and mononuclear cells from peripheral blood (PBMCs) were incubated in the presence of 0.9% NaCl or different concentrations of sufentanil or ketamine for 24 h. Then the stimulants-phorbolmyristate + lonomycin + glgistap (inhibitor of intracellular protein transport) were added to whole blood and phytohemagglutinin (PHA) was add to PBMCs. The whole blood was incubated for another 4h and PBMCs were incubated for another 48 h. Then the T-lymphocytes were collected for determination of intracellular level of IFN-?(as a marker of Th1 cells) and IL-4 (as a marker of Th2 cells) in the whole blood using three-color flow cytometry and the expression of CCR5 + (as a marker of Th1 cells) and CCR3 + (as a marker of Th2 cells) in PBMCs. The Th1/Th2 ratio was calculated. Results In sufentanil 0.5 and 5.0 ng?ml-1 groups the percentage of Th2 cells was significantly increased while the percentage of Th1 cells and Th1/Th2 ratio were significantly decreased. In ketamine 500 and 2 500 ng?ml-1 groups the percentage of both Th1 and Th2 cells were significantly decreased and the Th1/Th2 ratio was significantly increased. Conclusion Sufentanil can encourage helper cells to differentiate into Th2 cells while ketamine inhibit the helper cells to differentiate into Th1 and Th2 cells, especially the Th2 cells in a dose-dependent manner.

OBJECTIVE:To establish a method for analyzing the volatile oil of high-yield and high-oil Curcuma kwangsiensis, and to provide reference for its breeding. METHODS:GC-MS was performed on the column of HP-5MS quartz elastic capillary column,carrier gas was high purity helium(99.999%),flow rate was 1.0 ml/min,inlet temperature was 250 ℃,the initial tem-perature of column was 50 ℃(temperature programmed),split injection with split ratio of 10:1. Mass spectrometry conditions:ionization mode was the electron impact ion source,ionization energy was 70 eV,the ion source temperature was 230 ℃,the quadrupole temperature was 150 ℃, transmission line temperature was 280 ℃,the electron multiplier voltage was 1588 V,and mass scanning range was m/z 45 to 500. High-yield and high-oil germplasm of were screened from 100 different germplasms,the volatile oil composition of single plant and relative percentage contents of each composition were compared,SPSS 22.0 software was used for cluster analysis. RESULTS:Totally 10 high-yield and high-oil germplasm were screened,54 kinds of compounds were identified,the common compositions of 10 different germplasms were camphor,1-caryophyllene,γ-elemene,curcumene, gemma ketone and new curdione,most germplasms contained borneol,isoborneol,δ-elemene,germacrene and calamine. The C78,C104,purpose 2,volatile oil content and relative percentage contents of active compositions in volatile oil were high. The 10 high-yield and high-oil germplasms can be divided into 3 groups. CONCLUSIONS:The study basically clears the main chemicalcomposition of volatile oil of high-yield and high-oil C. kwangsiensis,C78,C104 and purpose 2 are the more excellent strains in high-yield and high-oil C. Kwangsiensis germplasm.

ObjectiveTo evaluate the effect of sufentanil preconditioning on acute lung injury induced by intestinal ischemia-reperfusion (I/R) in rats and the role of opioid receptors.MethodsForty-eight male Wistar rats weighing 200-250 g were randomly divided into 6 groups ( n =8 each):sham operation group (group S) ; I/R group; sufentanil preconditioning group (group SPC) ; COTP (μ receptor antagonist) + SPC group; NTD (δ receptor antagonist) + SPC group and nor-BNI (κ receptor antagonist) + SPC group.Intestinal I/R was produced by occlusion of the superior mesenteric artery for 45 min followed by 2 h reperfusion in groups I/R,SPC,COTP +SPC,NTD + SPC and nor-BNI + SPC.Sufentanil 10 μg/kg was injected intravenously at 10 min before ischemia in groups SPC,COTP + SPC,NTD + SPC and nor-BNI + SPC.COTP 1 mg/kg and NTD 5 mg/kg were injected intravenously at 10 min before sufentanil injection in groups COTP + SPC and NTD + SPC respectively,while nor-BNI 5 mg/kg was injected intravenously at 15 min before sufentanil administration in group nor-BNI + SPC.The animals were sacrificed at 2 h of reperfusion,the intestinal tissue was removed for microscopic examination and intestinal damage was assessed and scored according to Chiu.Left lung tissue was also removed for microscopic examination (1 =normal,4 =severely injured).The apoptosis in lung cells was detected using TUNEL and apoptosis index (AI) was calculated.The expression of Bcl-2 and Bax proteins in lung tissues was detected using immuno-histochemistry and Bcl-2/Bax ratio was calculated.ResultsCompared with group S,Chiu's score,lung injury score and AI were significantly increased,expression of Bcl-2 and Bax proteins was up-regulated,Bcl-2/Bax ratio was significantly decreased in the other groups ( P ＜ 0.01 ).Compared with group I/R,Chiu' s score,lung injury score and AI were significantly decreased,Bcl-2 protein expression was up-regulated,Bax protein expression was downregulated,and Bcl-2/Bax ratio was significantly increased in group SPC (P ＜ 0.01 ).Compared with group SPC,Chiu's score,lung injury score and AI were significantly increased,Bcl-2 protein expression was down-regulated,Bax protein expression was up-regulated,and Bcl-2/Bax ratio was significantly decreased in groups COTP + SPC,NTD + SPC and nor-BNI + SPC ( P ＜ 0.01 ).ConclusionSufentanil preconditioning can attenuate lung injury induced by intestinal I/R by activation of opioid receptors in rats.

Objective To explore whether Cdc42 is an independent influence factor in regulating the migration of A549 cells by using quantitative measurement method,and to verify the effectiveness of an automatic measurement and calculation method for in vitro cell migration assay.Methods Cdc42 was overexpressed in human lung adenocarcinoma A549 cell line,and then in vitro scratch assay was applied to evaluate the migration of the cells.Different methods were used to measure the images acquired at different time points for quantitative analysis.Accuracy and repeatability of different measurement methods were analyzed.Results The results showed that overexpression of Cdc42 alone significantly advanced the migration of A549 cells (P＜0.05).The new method is efficient,accurate and reproducible as compared to manual measurement,and has significant advantages in target recognition and noise removal as compared to the existing measurement method in Image Pro Plus 6.0.Conclusions Over expression of Cdc42 significantly increased A549 cell migration ability in vitro.The new method can realize the automatic quantitative analysis of cell migration in vitro.

Objective:To compare the clinical efficacy of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) in the treatment of infants with severe respiratory syncytial virus (RSV) pneumonia.Methods:A prospective randomized controlled trial was conducted. The infants with severe RSV pneumonia who received invasive mechanical ventilation admitted to intensive care unit (ICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2018 to December 2019 were enrolled. According to the order of admission, each infant was assigned to HFOV group or CMV group by random number table. The basic data, pediatric critical score, blood gas analysis, ventilator parameters, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO 2)/arterial partial pressure of oxygen (PaO 2)×100], duration of mechanical ventilation, length of ICU stay, complications, prognosis, use of muscle relaxants and vasoactive drugs and other clinical indicators of the two groups were recorded. Results:A total of 28 infants were enrolled in the analysis, including 15 infants receiving CMV and 13 infants receiving HFOV. There were no significant differences in age, body weight, pediatric critical score and OI before enrollment, type Ⅱ respiratory failure, multiple organ dysfunction, basic diseases and laboratory examination indexes before enrollment between the two groups. Six hours after enrollment, compared with CMV group, heart rate (HR), respiratory rate (RR), case of transcutaneous oxygen saturation (SpO 2) decrease, case of HR decrease, case of cardiopulmonary resuscitation (CPR) and OI in HFOV group were significantly decreased [HR (bpm): 130 (125, 138) vs. 144 (140, 160), RR (times/min): 35 (34, 38) vs. 40 (35, 45), SpO 2 decrease (case: 1 vs. 10), HR decrease (case: 0 vs. 6), CPR (case: 0 vs. 4), OI: 6.5 (4.4, 8.9) vs. 9.3 (8.0, 12.8)], while case of use of muscle relaxants (case: 3 vs. 0) and volume of 7-day positive fluid balance [mL/kg: 167.1 (113.8, 212.6) vs. 90.8 (57.8, 112.7)] were significantly higher, the differences were statistically significant (all P < 0.05). There was no use of blood purification treatment, no severe complications such as pneumothorax and intracranial hemorrhage, and no death within 28 days in the two groups. Conclusion:Compared with CMV, HFOV in the treatment of infants with severe RSV pneumonia can improve the oxygenation level and clinical physiological indexes earlier, reduce the incidence of adverse events such as HR, SpO 2 decrease and CPR, increase the use of muscle relaxants and the positive fluid balance, and do not increase the incidence of severe complications such as pneumothorax and intracranial hemorrhage, so its clinical application is safe.

Objective To study the effect of percutaneous transhepatic gallbladder drainage (PTGBD) combined with laparoscopic cholecystectomy (LC) in treatment of acute severe cholecystitis.Method The perioperative data of patients treated with PTGBD combined with LC and patients treated with emergency LC were analyzed.Results There were no significant difference between the two groups on surgical duration (t =0.601,P =0.551) and postoperative hospital stay (t =0.979,P =0.331).Blood loss [PTGBD + LC (79.43 ± 46.27) ml,LC (125.84 ± 64.18) ml ; t =3.641,P ＜ 0.05],peritoneal drainage time [PTGDB + LC (3.29 ± 1.58) d,LC (4.63 ± 2.31) d ; t =3.131,P ＜ 0.05] and postoperative oral intake time [PTGBD +LC (2.91 ±1.58)d,LC (4.21 ±2.22)d; t =2.669,P＜0.05] were significantly different between the two groups.The rate of laparotomy,mortality and postoperative complications in the emergency LC group were higher than those in the PTGBD combined with LC group.Conclusions PTGBD combined with LC in the treatment of acute severe cholecystitis was significantly better than emergency LC.

With the increasing pressure from society, work, and family, the number of patients with mental disorders such as depression and anxiety in China is on the rise. Human psychology, like the body, is divided into three states, including health, sub-health, and illness. However, in the early stages of changes in mental health status, most people are unable to detect it in a timely manner, which to some extent promotes the occurrence and progression of diseases. Psychological flexibility, as the cornerstone of mental health, is an important indicator for early assessment of mental health. This paper aims to elaborate on the concept, content, and measurement tools of psychological flexibility, explore the research status and development problems at home and abroad, and provide reference for promoting clinical psychological treatment and nursing care in China.

Objective:To study the chemical constituents in the roots of Tripterygium wilfordii. Methods: The compounds from Tripterygium wilfordii were isolated and purified by silica gel, Sephadex LH-20 and prep-HPLC chromatography, and their structures were elucidated based on the physiochemical properties and spectroscopic analysis. Results:Twelve compounds were isolated and iden-tified as wilforgine(1),wilforine(2),triptonoterpene methyl ether(3),glut-5-en-3β,28-diol(4),wilforol E(5),triptobenzene L (6),maytenoic acid(7),triptophenolide(8),celastrol(9),demethylzeylasteral(10),1-desacetyl wilforgine(11) and wilfortrine (12). Conclusion:The 1D and 2D NMR data of 1 and 2 are assigned for the first time,and the absolute configurations of 1 are con-firmed by X-ray single crystal diffraction.

Objective:To explore the relationship between hematocrit, early fluid therapy, and clinical outcomes in patients with septic shock, and to provide evidence for fluid resuscitation therapy and prognosis assessment in these patients.Methods:The clinical information of patients with septic shock who were diagnosed and treated in the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 1, 2018 to December 31, 2020 were collected. Taking the survival or death of patients 28 days after admission as the end point of clinical research, the patients were divided into the survival and death groups. After analyzing the basic data of the two groups, the univariate and multivariate COX regression analyses were used to analyze the evaluation value of Δ Hematocrit (HCT) d2-d1 and ΔHCT d3-d1 on the prognosis of patients with septic shock. At the same time, the Kaplan-Meier survival curve was used to analyze the overall survival rate of patients with septic shock, and the smooth curve fitting graph was used to verify its relationship with net fluid intake and death. Results:There were 241 cases in the survival group and 67 cases in the death group. Univariate COX analysis showed statistically significant differences between the survival and death groups in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) ( P=0.0006), red cell volume distribution width (RDW) ( P=0.0043), age ( P=0.0184), ΔHCT d2-d1 ( P=0.0136), ΔHCT d3-d1 ( P=0.0204), and white blood cell (WBC) ( P=0.0444). Multivariate COX analysis showed that ΔHCT d2-d1 ( P=0.0115) and ΔHCT d3-d1 ( P=0.0029) were independent risk factors for death in EICU patients with septic shock. ΔHCT d2-d1 and ΔHCT d3-d1 were divided into three groups according to the three-digit method. The Kaplan-Meier survival curve showed no significant difference among the three groups in the overall survival rate related to ΔHCT d2-d1 ( P=0.16), but there was a statistically significant difference in the overall survival rate among the three groups related to ΔHCT d3-d1 ( P=0.025). The smooth fitting curve of ΔHCT d3-d1, net fluid intake, and prognosis showed that ΔHCT d3-d1 was negatively correlated with net fluid intake, and the middle ΔHCT d3-d1 group had the best prognosis. Conclusions:The value of ΔHCT d3-d1 is related to the net fluid intake of patients with septic shock. An appropriate decrease in HCT on the third day can improve the prognosis of patients with septic shock. The dynamic changes of hematocrit can provide a certain basis for fluid resuscitation and prognosis evaluation in patients with septic shock.