Objective To compare the effects of different analgesic methods in patients undergoing hip surgery followed by low-molecular-weight heparin administration.Methods A total of 94 ASA Ⅰ-Ⅱ patients undergoing hip surgery with combined spinal and epidural anesthesia (CSEA) who had received a single dose of 2 mg epidural morphine were randomized into 3 groups:Group M (n=30,patients receiving a single dose of epidural morphine combined with intramuscular tramadol if VAS≥4),Group E [n=34,patients receiving a single dose of epidural morphine combined with patient-controlled epidural analgesia (PCEA)],and Group Ⅰ [n=30,patients receiving a single dose of epidural morphine combined with patient-controlled intravenous analgesia (PCIA)].Infusion quantity during operation,bleeding volume and postoperative drainage volume,visual analogue scales (VAS) 24 h and 48 h after operation,Ramsay sedation scores,and nausea and vomiting were recorded.Venous blood samples were taken at admission,the end of operation,and 24 h,48 h and 7 d after operation for hemorheological data,coagulation tests and blood platelet counts (PLT).Color Doppler ultrasonography of lower limb vessels was conducted by the same clinician before and 7 days after operation.Results VAS at 48 h after operation were higher in Group M than in Group E and Group Ⅰ,and there were more patients refusing to initiate ambulation because of pain in Group M than in Group E and Group Ⅰ (P＜0.01).Ramsay scores at 24 h and 48 h in Group Ⅰ were higher than those in Group M and Group E,and there was no significant difference in Ramsay scores between Group M and Group E (P＞0.05).The occurrence of post-operative nausea and vomiting (PONV) was higher in Group M and Group Ⅰ than in Group E (P＜0.05),and there were more patients refusing to initiate ambulation because of nausea and vomiting in Group M and Group Ⅰ than in Group E (P＜0.01).There was no significant difference in DVT occurrence,hemorheological parameters or coagulation function between the 3 groups (each P＞0.05).Conclusions A single dose of epidural morphine does not achieve satisfactory analgesia,as evidenced by a large proportion of patients refusing to initiate rehabilitation training due to pain,and the incidence of PONV is high in elderly patients undergoing hip surgery.A single dose of epidural morphine combined with PCIA offers enhanced analgesia,but it also results in increased PONV.A single dose of epidural morphine combined with PCEA provides improved analgesia and reduced PONV,but shows no added advantage with the application of low-molecular-weight heparin in deep venous thrombosis prevention.

Objective To analyze the clinical application of misoprostol in the painless induced abortion analgesia.Methods 80 cases of painless induced abortion in pregnant women were selected as the subjects.They were randomly divided into two groups by the digital table method.The control group was not given drug before opera-tion,the observation group was given oral misoprostol before operation.The blood loss, operation time and adverse reaction rate of the two groups were observed and compared.Results In the control group,blood loss[(82.13 ± 8.76)mL],operation time[(15.64 ±4.43)min],and adverse reactions rate(30.00%) were higher than those in the observation group[(46.51 ±5.31)mL,(11.36 ±3.22)min,7.50%],the differences between the two groups were statistically significant(t=4.57,3.36,χ2 =6.65,all P<0.05).Conclusion Oral misoprostol before operation could reduce the amount of bleeding during operation,shorten the operation time.It was worth of popularizing.

The paper retrieves SCI papers related to medical treatment cloud and analyzes the current research direction of this topic.It makes the bibliometric analysis of SCI papers on this topic in Web of Science TM core integrated database,counts up the occurrence frequency of high-frequency subject terms in the same document and generates the co-occurrence matrix.By clustering analysis of various document contents in the matrix with SPSS,it obtains the research direction of this topic.

Objective To assess stress degree of osteosarcoma caregivers and explore the impact factors of stress response. Methods We used CRA scale to investigate stress state of the primary caregivers of osteosarcoma patients, the demographic characteristics, status of patients, the objective amount of care and scores for each latitude underwent multiple regression analysis. Results The pressure of caregivers from the city was relatively light, annual income more than 50 thousand yuan and with help from the families to take care patients could effectively alleviate the pressure. The caregivers came from rural areas, household income less than 20 thousand yuan, caregivers were the patients' parents, had their own job presently, with no one to help were high - pressure groups. Conclusions Caregivers of osteosarcoma patients with high-pressure need focused intervention, more help and support should be given to these population.

Objective To explore the feasibility of using unilateral continuous spinal anesthesia(UCSA)with hypobaric levobupivacaine in elderly patients undergoing hip replacement.Methods Sixty ASAⅠ~Ⅲ patients aged 63~91 were randomized to one of two groups:group U unilateral continuous spinal anesthesia(UCSA)(n=30)and group S single spinal epidural anesthesia(SSEA)(n=30).Patients in group U were performed at L2,3 or L3,4 interspace with the patients in the lateral position with the diseased leg upper most.The patients received a continuous spinal catheter,Hypobaric 0.375% levobupinacaine solution 0.5～1.0ml was injected.If analgesia did not reach T10 after 5～10min the same dose was repeated.Patients in group S were performed at L2,3 or L3,4 interspace with the patients in the lateral position with the diseased leg down most.Hyperbaric 0.375% bupivacaine solution 3 ml was injected into subarach noid through spinal needle,which was threaded through epidural needle.Then epidural catheter was placed.The position was adjusted to the analgesia level to reach T10.Parameters of circulation and respiration function were recorded.The level of block and degree of motor blockade were measured and recorded.The intraoperative and postoperative complication associated with spinal or epidural anesthesia were recorded.Results MAP was slightly decreased after initial dose of local anesthetics as compared to the baseline MAP in both groups.The incidences of hypotension was significantly lower in group U than in group S.There was no significant decreasement in SpO2 and no significant change in HR during operation in both groups.There was lower sensory block in group U than in group S.There was no significant difference in degree of motor blockade,dose of innovar,incidences of tremble,nausea and vomiting,headache and neural complication after operation between the two groups.Conclusion Both UCSA and SSEA can produce satisfactory sensory block for hip replacement.But UCSA can produce stabler hemodynamics and is anesthesia method of choice in elderly patients undergoing hip replacement.

The paper uses bibliometrics method to analyze literatures in Web of ScienceTM relevant to remote medical education pub-lished from 2005 to 2015 and carries out cluster analysis, works out the main research directions in recent 10 years including evaluation of remote medical education in light of META Analysis;utilization of remoted medicine technology in continuing medical education;dis-cussion on the route, approach and experience of developing remote medical education; the method to enhance the medical care level, improve health of the patients and further raise their life quality.

OBJECTIVE: To develop a new method for the determination of chamaechromone in urine and feces of rats and investigate its excretion characteristics. METHODS: A liquid chromatography tandem mass spectrometry (LC-MS) method was developed. Chromatographic separation was performed on Xbridge™G18 column (2.1 mm×50 mm, 3.5 μm) with linear gradient elution u-sing water and methanol, both of which were acidified with 0.1% aqueous formic acid. The flow rate was 0.4 mL·min-1. Detection was performed on a triple-quadrupole tandem mass spectrometer using positive ion mode electrospray ionization (ESI) in multiple reaction monitoring (MRM) mode. The monitored MS/MS ion transitions were m/z 543.3→198.9 and 481.9→258.3 for chamaechromone and rosuvastatin, respectively. RESULTS: Good linearity was observed over the concentration range of 8-6 400 ng·mL-1 in 0.1 mL of both rat urine and feces. The limit of detection (LOD) was 4 ng·mL: The intra-assay and inter-assay variabilities were less than 14% in both urine and feces. Cumulative urinary and fecal excretion ratios within 48 h at a dose of 100 mg·kg-1 after oral administration of chamaechromone accounted for (1.84±0.290)% and (41.5±6.917)% of the dose respectively. CONCLUSION: This method shows excellent sensitivity, precision, and accuracy, and is successfully applied to evaluate the excretion of chamaechromone in urine and feces of rats. The results indicate that feces are the major excretion route of chamaechromone after oral administration. And the most efficient excretion happens in 12-24 h after administration.

Objective To assess the influence of atrial fibrillation on post-thrombolytic hemorrhagic transformation and functional prognosis in acute ischemic stroke patients within different time window.Methods We retrospectively reviewed the clinical and imaging data of patients of acute ischemic stroke with intravenous thrombolysis admitted from June 2009 to October 2013.According to onset-to-needle time,we divided patients into 3 groups and then assessed the effect of the comorbidity with atrial fibrillation on the occurrence of hemorrhagic transformation and favorable outcome (defined as modified Rankin Scale score≤2 at 90 days) after thrombolysis within different time window.Results A total of 345 patients were included in this study,among whom 101 (29.3％) were treated by intravenous thrombolysis within 3.0 h (≤3.0 h),157(45.5％) ＞3.0 h and≤4.5 h,87(25.2％) over 4.5 h(＞4.5 h).Atrial fibrillation was observed in 50.5％ (51/101) patients in ≤3.0 h group,37.6％ (59/157) in ＞3.0 h and≤4.5 h group and 40.2％ (35/87) in ＞ 4.5 h group (x2 =4.362,P =0.113).There were no statistically significant differences among these three groups about the rate of hemorrhagic transformation (hemorrhagic infarction:16.8％ (17/101),22.3％ (35/157),20.7％ (18/87),and parenchymal hematoma:5.0％ (5/101),10.2％ (16/157),10.3％ (9/87),x2 =4.278,P =0.370) and favorable outcome (51.5％ (52/101),53.5％ (84/ 157),47.1％ (41/87),x2 =0.913,P =0.633).Multivariate analysis demonstrated that atrial fibrillation was associated with hemorrhagic infarction for patients in ＞ 4.5 h group (OR =3.637,95％ CI 1.101-12.013,P =0.034),and the presence of atrial fibrillation independently predicted parenchymal hematoma for patients in ＞ 3.0 h and ≤4.5 h group (OR =3.757,95％ CI 1.133-12.457,P =0.030).There was no significant association between atrial fibrillation and favorable outcome at 90 days.Conclusions The presence of atrial fibrillation is not associated with the prognosis in thrombolytic patients.However,it enhanced the risk of parenchymal hematoma if patients were treated within the time window ＞ 3.0 h and ≤4.5h.

Objective:To discuss the choice of anti-infective drugs and the significance of pharmaceutical care for COPD patients with pulmonary infection. Methods:Clinical pharmacists performed pharmaceutical care for a COPD patient with pulmonary infection including such aspects as drug selection, treatment course, drug interaction, adverse reactions and so on. Results:By providing phar-maceutical care for the patient, the problems in the treatment were identified and solved in time, and the rationality of drug treatment was improved. Conclusion:By participating in clinical practice, clinical pharmacists can assist physicians in improving the safety and efficacy of drug treatment and providing pharmaceutical care for patients.

Objective To investigate the discharge outcome and its clinical influential factors of acute poisoning in children, and to provide the clinical references for prevention. Methods Questionaire about acute poisoning in children made by the research group,the hospitalized children and the influential factors were analyzed according to the outcome. Results Among 168 cases of acute poisoning hospitalized children,the curative rate was 80.95%, 16 cases(9.52%) were improved,6 cases (3.57%)were quitted,1.20% was ' not curative' and 4. 76% died. The factors including age,treatment time, route of entry, varieties of poison, medical examination of admission were statistically associated with the discharge outcome.Conclusion The outcome can be improved through an intensive nurse of the children under the age of three and early treatment. The cases who were not poisoned by the invasion of gastrointestinal tract,paraquat poisoning,and those with abnormalities of breathing, pupilla, awareness in medical examination of admission would have poor discharge outcomes, and should be monitored closely and treated timely.