Objective To explore the effect of dexmedetomidine(DEX)for blood pressure,heart rate(HR) and SpO2 levels during anesthesia inquiry in elderly hypertensive(HBP)patients.Methods 96 cases with HBP accepted surgery were selected,and were randomly divided into the observation group and the control group,each group in 48 cases,The patients in the observation group continuous pumped into the 4μg/mL of DEX during surgery, while the control group continuous pumped into 0.9% sodium chloride solution during surgery.Heart rate(HR),sys-tolic blood pressure(SBP),diastolic blood pressure(DBP),pulse oxygen saturation(SpO2 )of the two groups after room entrance(T0),after DEX infusion(T1),before intubation(T2),after 2min intubation(T3)and 10 min(T4)after intubation were recorded and compared,extubated time,spontaneous breathing recovery time,call time to eye opening and hospitalization time and the incidence of adverse reactions in two groups were recorded.Results The difference of HR SBP,DBP and SpO2 at T0 and T4 between the two groups was not statistically significant(all P >0.05);HR, SBP and DBP were significantly lower in the observation group than those in the control group at T1,T2,T3(all P <0.05).There were no significant changes of SpO2 in the patientˊs after the room entrance;extubated time,spontaneous breathing recovery time,call time to eye opening and hospitalization time in the observation group were significantly lower than those in the control group(t =8.874,9.073,8.573,all P <0.05).The adverse reactions rate in the observation group was 4.2%,which in the control group was 6.3%,the difference was not statistically significant(P >0.05). Conclusion Continuous pumped DEX has a significant sedative effect in elderly HBP patients during surgery,and does not produce respiratory depression,can help elderly patients with HBP smoothly pass the perioperative period.

In order to explore more reasonable and scientific accounting method of community health service costs, to improve the accounting method system of community health service cost. In the current existing community health services costing methods, based on the analysis of hospital cost accounting methods system, analyze and imitate the accounting method of hospital costs, establish a more scientific and implemented accounting method system of community health service costs: divide parts of clinics scientifically, redesign the center acollation method of indirect cost, confirm different cost accounting methods for different cost accounting objective and provide suggestion for the improvement of project cost accounting.

To observe the histopathological changes of mice experimentally infected with plerocercoid,mice were infected orally by plerocercoids that were collected from Rana nigromaculatus (5 strips/mouse),and were killed 2-10 weeks later to undergo the histopathological observation.Plerocercoids were found in the skin,muscle,liver,lung cavity of mice.There were diffuse congested spots and capsule formation ;the fat tissue showed severe degeneration and necrosis.In the fibrous tissues ,moderate proliferation of the enveloping adipose tissue was demonstrated.In addition,a large number of acute and chronic inflammatory cell infiltration and abscess formation could be found.It is evident that the plerocercoids parasitize mainly in the subcutaneous tissues and muscles of mice.and mice experimentally infected with plerocercoids show different degree of histopathological changes.

Objective To analyze the effects of dominant hand position on the quality of external chest compression for cardiopulmonary resuscitation (CPR) by the employment of the high-fidelity real-time feedback manikin system.Methods A total of 228 medical students of Wuhan University were enrolled in 2013 after standard CPR training courses.Participants were brought to a simulation scenario in which an adult happened to have heart arrest out of a hospital.Each studeut was asked to do five cycles of conventional CPR.In accordance with the dominant hand and the actual compressing hand position,the students were divided into dominant hand (DH) group and non-dominant hand (NH) group.Comparisons of chest compression rate,chest compression depth and chest recoil between two groups were carried out,respectively.The data were analyzed by the software of SPSS 13.0.Results There was no significant difference in overall chest compression rate between two groups (P ＞ 0.05) while the frequency distributions of chest compression rate showed differences (P ＜0.01),and chest compression rates above 100 cycle per min in DH group were higher than that in NH group (97％ vs.92％,P =0.002).There was significant differences in chest compression depth between two groups (DH 44±8 mm vs.NH 43±8mm,P=0.001).In NH group,the depth in cycle 5 (41 ±8) mm is obviously less than that in cycle 1 (44 ±7) mm,cycle 2 (43 ±7) mm and cycle 3 (43 ±8) mm.Totally,there was no differences in chest recoils between two groups [NH (98 ±8)％ vs.DH (97 ± 10)％,P =0.13],but full chest recoils were seen more in NH group (85％ vs.79％,P ＜ 0.05).Conclusions The dominant hand position can improve the quality of CPR resulted from the higher compression rate,deeper compression depth as well as delayed fatigue.

BACKGROUND:The research at home and abroad for appropriate immature myocardial cardioplegia has no breakthrough, and it may be a better mean to improve the protection effect of existing cardioplegia on immature myocardial by adding ingredients. Adenosine can reduce ischemia and neutrophil-mediated reperfusion injury, and salvia miltiorrhiza can reduce the content of ischemic myocardial lipid peroxide and increase the scavenging of myocardial cells to oxygen radical. OBJECTIVE:To investigate the protection effect of improved myocardial protection fluid containing adenosine and salvia miltiorrhiza on the heart, liver and kidney. METHODS:Sixty cases of infant open heart operation of the first time were randomly divided into three groups, 20 cases in each group. The adenosine group received the improved myocardial protection fluid added with adenosine, the combination group received the improved myocardial protection fluid added with adenosine and miltiorrhiza salvia, and the control group received the improved myocardial protection fluid in the same volume. The blood samples were taken at the time before anesthesia induction, 30 minutes after cardio pulmonary bypass beginning, 1 hour after cardio pulmonary bypass end and 24 hours after cardio pulmonary bypass end. The serum levels of the creatine kinase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, tumor necrosis factor-α, interleukin-6, interleukin-8 and interleukin 10 were detected. RESULTS AND CONCLUSION:The serum levels of the alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and creatine kinase in three groups were increased, but the control group was increased significantly (P<0.01), and there were significant differences between adenosine group and combination group (P<0.05);the levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 were significantly increased after operation (P<0.05). The levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 in the control group were significantly higher than those in the adenosine group and combination group before induction and at the same time point (P<0.01);at 3 minutes and 24 hours after cardio pulmonary bypass, the level of interleukin-10 was increased in three groups, but the level of interleukin-10 in the adenosine group was significantly higher than that in the control group (P<0.01). The results indicate that improved myocardial protection fluid has great protection effect on immature myocardial, and can significantly reduce the serum levels of tumor necrosis factor-α, interleukin-6 and interleukin-8, promote the secretion of interleukin-10 that can inhibit inflammatory cytokine and can significantly reduce the inflammatory response caused by cardiopulmonary bypass. So the improved myocardial protection fluid has protection effect on important organs, such as heart, lung, liver and kidney.

Objectives To understand essential basis data availability for implementation of cost accounting in TCM hospitals. Methods Costs of a total of 1588 TCM hospitals were investigated by conducting the baseline survey via questionnaires in 2013. Results Departmental basic data (including ratio of office staff and entire staff, ratio of outpatient and inpatient departments in clinical department), and construction data for housing were well accessible, while utility fee and internal service data were not. Conclusion ①Public TCM hospitals need to improve and specify the basic cost data. ②Differences exit among different types and levels of hospitals in the availability of data. ③There are still difficulties in carrying out cost accounting in public TCM hospitals, which needs strong supports from all relevant departments.

Objective To evaluate the role of combination of three-vessel views in ultrasound diagnosis of fetal aortic arch and pulmonary arterial branch anomalies.Methods The data of 66 cases of fetal aortic arch and pulmonary arterial branch anomalies were retrospectively analysed,including echocardiographic data,autopsy and operation records and postnatal follow-up results.Echocardiogaphic features and display frequencies on three vessels and trachea view(3VT),three vessels view(3VV)and three vessels and pulmonary arterial branches view(3VP)were summarized.Results There were 52 cases of aortic arch abnormalities,including 32 cases of right aortic arch with left ductus arteriosus,4 cases of double aortic arch,7 cases of aberrant right subclavian artery,6 cases of coarctation of aorta and 3 cases of interruption of aortic arch.Fourteen cases were diagnosed pulmonary aterial branch abnormalities,including 1 0 cases of crossed pulmonary arteries,2 cases of anomalous origin of left pulmonary artery from aortic arch and 2 cases of pulmonary artery sling.The display frequencies of fetal aortic arch and pulmonary arterial branch anomalies on 3VT,3VV and 3VP were 80.3%,19.7% and 39.4%.Conclusions The combination of three-vessel views is of great value in prenatal diagnosis of fetal aortic arch and pulmonary arterial branch anomalies.

Objective To understand the basic situation and existing problems of cost accounting information construction in the traditional Chinese medicine hospital. Methods We made a cross-sectional study of all traditional Chinese medicine hospitals cost accounting informatization, and then analyzed the results. Results In the survey of 1588 traditional Chinese medicine hospitals, there exists the problem with 78.65%for limited software;57.43%for not sharing between the systems;43.20%for outdated software. The occupancy rate was 81.86%for HIS system, 87.09%for the accounting software, 39.11%for cost accounting software, 5.42%for none. The proportion of hospitals was over 95% whose income data statistics to department;80% for spending data;73.05%for fixed assets depreciation cost;51.39%for amortization of intangible assets and 52.77%for medical risk fund. The proportion of hospitals was 81.49%whose data inside services statistics to medical auxiliary departments and higher than the logistics department, which was 63.85%.Conclusion The occupancy rate of cost accounting system software was limited in traditional Chinese medicine hospitals. The problems were limited cost accounting system software and unavailable information shared between the systems.

AIM: To screen the lentiviral vector carrying siRNA with higher efficiency of suppressing the sphingosine-1-phosphate receptor 2 (S1P2) gene expression in the primarily cultured corpus cavernosum smooth muscle cells of spontaneously hypertensive rats (SHR).METHODS: SHR and SD rats (n=5 each) were used for primarily culturing corpus cavernosum smooth muscle cells.The cells were randomly divided into 6 groups: SHR siRNA-1, SHR siRNA-2, SHR siRNA-3, SHR GFP, SHR control (SHR non-transfection group), and SD control (SD rat control group).Each group had 5 samples with 1.0×105 cells of each sample.At 72 h after transfection (MOI=60) with lentiviral vectors carrying S1P2 siRNA into the SHR corpus cavernosum smooth muscle cells, the expression of GFP was observed under fluorescence microscope.The protein expression of S1P2, ROCK1, ROCK2 and eNOS in the corpus cavernosum smooth muscle cells, and the mRNA expression of S1P2, ROCK1 and ROCK2 were determined by by Western blot and RT-PCR.RESULTS: The transfection efficiency of the corpus cavernosum smooth muscle cells in SHR siRNA-1, SHR siRNA-2, SHR siRNA-3 and SHR GFP groups were>80%.Compared with SHR control group, the mRNA levels and the protein expression of S1P2, ROCK1 and ROCK2 in SHR GFP group showed no remarkable changes, while those in SHR siRNA-1, SHR siRNA-2, SHR siRNA-3 and SD control groups were significantly lower than those in SHR control group (P<0.05).The protein expression of eNOS in SHR siRNA-1, SHR siRNA-2, SHR siRNA-3 and SHR GFP groups were not significantly changed as compared with SHR control group, but that in SD control group was significantly higher than that in SHR control group.CONCLUSION: Three groups of siRNA lentiviral vectors targeting S1P2 inhibit the expression of S1P2 in the corpus cavernosum smooth muscle cells of SHR, and by silencing the S1P2 expression, the expression of ROCK1 and ROCK2 is inhibited.Among them, siRNA-1 has the highest inhibitory efficiency.

Objective To examine the availability of emergency medical services(EMS) for patients with acute stroke and to investigate influential factors affecting the preference of patients'to EMS.Methods Consecutive information of patients with acute stroke who presented to the emergency department of Zhongnan Hospital of Wuhan University from June 1, 2014 to December 31, 2015 were analyzed.Gender, age of patients, transport modality, risk factors in cerebrovascular diseases, initial symptoms, stroke types, onset and admission time were included to make analysis in retrospective study.The participants were divided into two groups based on the preference of patients, namely EMS group and self-transport group.Wilcoxon rank sum test or Chi-squared test was used to statistical analysis as appropriate.A multiple binary logistic regression was used to determine the relationship between various patient-related factors with probability whether patients chose EMS or not.Results Among the 240 patients, only 29.2%of them asked for the EMS at the onset of symptoms (EMS group, n=70), and the rest patients called for other services(self-transport group, n=170).Logistic regression analysis revealed that the patients with the symptom of altered consciousness or convulsion (95%CI:0.107-0.403,OR=0.208,P<0.01) were more likely to use EMS.The time consumed from onset to visit of patients with acute stroke to emergency physician was significantly shorter in EMS group (M, 60 min vs.180 min,P<0.01).Conclusion The symptom of altered consciousness or convulsion was the independent factor to determine whether patients with acute stroke preferred EMS or not.