Objective To evaluate the effect of dexmedetomidine alternative to propofol administered in general anesthesia on maintainance and recovery in patients undergoing gynecologic laparoscopy.Methods One hundred and twenty patients undergoing gynecologic laparoscopy,were divided into group C,D1 and D2 with 40 cases each by random digits table method.Group C received propofol 100 μ g / (kg min) and remifentanil 0.10-0.25 μ g / (kg min) intravenous infusion,group D1 received propofol 100 μ g/(kg min),remifentanil 0.10-0.25 μ g/(kg min) and dexmedetomidine 0.2 μ g/(kg h) intravenous infusion,while group D2 received dexmedetomidine 2.0-3.0 μ g / (kg h) and remifentanil 0.10-0.25 μ g/ (kg min).Cis-atracurium was given on time to maintainance of anesthesia.The heart rate (HR),mean arterial pressure (MAP) were recorded at the following time points:arriving at operating room (To),anesthesia induction (T1),intubation (T2),skin incision (T3),pneumoperitoneum (T4),10 min after pneumoperitoneum (T5),20 min after pneumoperitoneum (T6),the end of operation (T7),discharge from post anesthesia care unit(T8) and the first postoperative day (T9).The time of emergence,extubation and duration in post anesthesia care unit were recorded too.Ramsay scale and Riker Sedation-Agitation Scale on emergence,extubation and discharge from post anesthesia care unit and post anesthesia recovery score at T9 were also recorded.Results The MAP in group D2 was higher at T3 to T7 time-points than that in group C and group D1 [(93 ± 10),(99 ± 11),(94 ± 13),(95 ± 10),(91 ± 10) mm Hg (1 mm Hg =0.133 kPa) vs.(88± 11),(90± 10),(87±9),(86±9),(83±8)mmHgand (87±9),(90± 10),(86±8),(85 ±7),(83 ± 7) mm Hg],there were significant difference (P ＜ 0.05).There were no significant difference among groups on the HR at each time point and the time of emergence,extubation and duration in post anesthesia care unit (P ＞ 0.05).Ramsay scale was lower on emergence and Riker Sedation-Agitation Scale was higher on emergence and extubation in group C than that in group D1 and group D2 [(3.7 ± 1.3) scores vs.(4.0 ± 0.9),(4.2 ±0.9) scores,(3.1 ± 1.0) scores vs.(2.8 ±0.6),(2.7 ±0.9) scores,(3.3 ±0.7) scores vs.(3.2 ± 0.4),(3.0 ± 0.5) scores],there were significant differences (P ＜ 0.05).Riker Sedation-Agitation Scale was higher on extubation in group D1 than that in group D2(P ＜ 0.05).Post anesthesia recovery score at T9 in group D2 was apparently increased compared with that in group C and group D1 [(108 ± 10) scores vs.(93 ± 13),(93 ± 15) scores] (P ＜ 0.05).Conclusions Dexmedetomidine 2.0-3.0 μ g/ (kg h) administered in general anesthesia on maintainance in gynecologic laparoscopy can improve the quality of extubation and promote postoperative recovery without prolonging extubation time,but have a influence on hemodynamic changes at early stage of pneumoperitoneum.

A novel method based on cross sensitivity of cataluminescence (CTL) generated on the surface of a nanometer composite oxide was proposed for simultaneous determination of benzene and trimethylamine (TMA) in air. A variety of nanometer composite oxides based on Y2 O3 that showed catalytic activity to many gas molecules were synthesized. For the fabrication of the detector, nanometer composite oxide was directly coated on the ceramic rod to form a 0. 1-0. 15 mm thick layer. The ceramic rod with nanometer composite oxide was inserted into a quartz tube with an inner diameter of 10 mm. The temperature of nanometer composite oxide was controlled by the digital heater. When gas samples passed through the nanometer composite oxide in the quartz tube by the air flow, the CTL was generated during the catalytic oxidation on the surface of the nanometer composite oxide. The CTL signals were respectively recorded by two ultra weak chemiluminescence analyzers. The CTL intensity and selectivity for the determination of benzene and TMA on nano- Zr3 Y2 O9 which was characterized by TEM were bigger and better than those on other nanosized composite oxides. The optimum experimental conditions were tested. Selective determination was achieved at a wavelength of 440 nm for benzene and 540 nm for TMA. The surface temperature of the nanometer materials was about 313 ℃. The flow rate of air carrier was about 140 mL/ min. The limit of detection of this method was 0. 30 mg / m3 for benzene at 440 nm and 0. 70 mg / m3 for TMA at 540 nm. The linear range of CTL intensity versus concentration of benzene at 440 nm was 0. 8-105. 0 mg / m3 , benzene at 540 nm was 3. 0-130. 0 mg / m3 , TMA at 440 nm was 2. 5-232. 0 mg / m3 and TMA at 540 nm was 1. 2-156. 0 mg / m3 . The recovery of 5 testing standard samples by this method was 96. 8% -102. 3% for benzene and 97. 6% -103. 4%for TMA. Common coexistence matters, such as formaldehyde, ethanol, acetone, ammonia, sulfur dioxide and carbon dioxide, did not disturb the determination. The relative standard deviation (RSD) of CTL signals of a continuous 200 h detection of gas mixture of 50 mg / m3 benzene and 50 mg / m3 TMA was 2. 0% , which demonstrated the longevity and steady performance of nano-Zr3 Y2 O9 to benzene and TMA under this experimental conditions.

Objective To explore the relationship between blood glucose level and blood pressure variability in hypertensive patients. Methods A total of 125 hypertensive patients hospitalized in the department of cardiology in our hospital during May 2015 to October 2016 were retrospectively analyzed. Patients were divided into hypertension with diabetes mellitus group (n=59) and hypertension without diabetes mellitus groups (n=66). Data of blood pressure, blood pressure variability and blood glucose levels were analyzed in the two groups. Results (1) Hyperlipidemia, low density lipoprotein and cholesterol levels were significantly lower in the hypertension with diabetes mellitus group than those of hypertension without diabetes mellitus group. Level of glycosylated hemoglobin (HbA1c), 24 h diastolic pressure variability coefficient (24 hDBPCV), daytime systolic blood pressure variability coefficient (dSBPCV), and daytime diastolic pressure variability coefficient (dDBPCV) were significantly higher in the hypertension with diabetes mellitus group than those of hypertension without diabetes mellitus group (P<0.05). (2) Spearman correlation analysis showed that hypertension with diabetes mellitus was positively correlated with 24 hDBPCV, dSBPCV and dDBPCV. (3) ROC curves of HbA1c for diagnosis of non-dipper blood pressure in hypertensive patients showed that the cut-off value of HbA1c was 5.85%and the area under curve was 0.692 (P<0.05). The sensitivity was 71.1% and the specificity was 63.7%. Conclusion The present results demonstrate that blood pressure variability is increased in hypertension patients with higher blood glucose. HbA 1c level has potential clinical value for diagnosis of non-dipper blood pressure in hypertensive patients.

Objective:To evaluate the validity and reliability of the Chinese version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) in female patients with eating disorders.Methods:A total of 239 patients with eating disorder and 142 healthy controls who were recruited consented to participate in the study and completed Chinese EDE-Q 6.0.Confirmatory factor analysis was used in patients to compare the original 4-factor model,1-factor model and 3-factor model.The criterion validity was tested with the Eating Disorder Inventory (EDI).Mann-Whitney U analysis was used to compare the differences of EDE-Q 6.0 scores on the two samples to test the empirical validity,and ROC analysis was used to determine the cut-off value.The internal consistency of the scale was tested in two samples.Among all participants,89 patients and 31 healthy controls were retested 1 month later.Results:The original 4-factor model fit better than the other two.The EDE-Q 6.0 total score and the EDI total score had a high consistency in the total sample,patients and controls,respectively (ICC =0.88,0.87,0.73).Patients had higher scores on the EDE-Q 6.0 than controls (Ps ＜0.01).The mean area under the curve (AUC) of EDE-Q 6.0 was 0.91,the optimal cut-off point of EDE-Q 6.0 was total score ≥ 1.27,sensitivity and specificity were 79.4％ and 88.2％ respectively.The Cronbach α coefficients were 0.95,0.91,and 0.88 for the total sample,patients and controls respectively.The test-retest reliabilities were 0.73 for the total scale,0.58,0.68,0.69 and 0.71 for the 4 factors.Conclusion:The Chinese version of the Eating Disorder Examination Questionnaire 6.0 have good psychometric properties and diagnosis accuracy,and it could be used to assess the severity of clinical symptoms.

Objective To explore the effect of ventilator circuit change frequency on the incidence of ventilator-associated pneumonia (VAP). Methods Patients receiving mechanical ventilation in the ICU,Department of Emergency, Respiratory Department and Department of Neurosurgery from March 2008 to September 2010 were randomized into two groups. For these two groups ,the ventilator circuit was changed once or twice a week. The recorded parameters included the clinical symptoms and signs of the ventilated patients. Samples at different parts of the circuit were collected for microbiological detection. The data were analyzed statistically. Results The incidence of VAP was 28. 30% ( 13/53 ) in twice-a-week group and 35.84%( 19/53 ) in once-a-week group. There was no significant difference between the two groups. The rates for positive microbiological detection in the circuit were 48. 16% and 44. 49% for once-a-week and twice-a-week group,respectively. No significant difference was observed ( P ＞ 0.05 ). Moreover, there was no significant difference in terms of the microbiology positivity between different parts of the circuit(P ＞ 0. 05 ). Gram-negative bacteria were the main pathogen of VAP with Acinetobacter baumannii ranking at the top. Conclusion Frequency of Ventilator circuit change does not influence the incidence of VAP. We suggest that the frequency for ventilator circuit change should be once a week. At the same time, the nurse staff should be trained for specific technology and the incidence of hospital infection should be controlled at multiple rings of the chain.

Objective To evaluate the feasibility and outcomes of different surgical approaches on the basis of sentinel lymph node biopsy (SLNB) in treating early-stage vulvar cancer, and discuss the proper strategy for individualized treatment. Methods The medical charts of patients with early-stage vulvar cancer treated in Sun Yat-sen University between January 2004 and December 2013 were retrospectively collected. A total of 74 patients who received sentinel lymph node(SLN)detection in primary surgery were enrolled (average age 55). The surgical approaches contained SLNB, inguinal lymphadenectomy (IL), and extensive vulvectomy. The SLN were examed on intraoperative frozen sections. The treatment protocols, lymphatic metastasis, postoperative recovery condition, recurrence and survival data were collected and analyzed. Results At least one SLN was successfully detected in 68 (92%,68/74) patients. SLN were positive in 21 patients, of whom 12 (group A) underwent bilateral IL, and 9 (group B) received radiotherapy without performed IL. SLN were negative in 47 patients, of whom 26 (group C) underwent bilateral IL and one of them had a non-SLN metastasis, and 21 (group D) were advised to follow-up. The coincidence of pathological results between frozen and paraffin sections was 100%. The sensitivity and specificity of SLNB for diagnosis of lymph node metastasis were 95% and 100%, respectively. A total of 44 complications happened in patients underwent SLNB and IL (group A and C), including 16 poor wound healing, 14 lymphedema, 8 lymphatic fistulas, 3 phlebothrombosis and 3 infections. There were no complications happened in patients underwent SLNB alone (group B and D), among whom the operation time, bleeding amount, and hospital stay were also significantly less than those in patients underwent SLNB and IL. The median follow-up time was 41 months and the 3-year overall survival rate was 85% in the whole series. Recurrences were observed in 11 patients and 9 of them died of the tumor with the median survival time of 15 months. In patients with positive SLN (group A and B), the 3-year overall survival rate was 58% with 8 patients died of the disease, including 4 in group A and 4 in group B. In patients with negative SLN (group C and D), the 3-years overall survival rate was 97% with one patient in group D died of the tumor, and significantly higher than that of patients with positive SLN (P=0.003). The 3-year overall survival rate was significantly difference. In univariate analysis by log-rank test showed that, neither in patients with nor without SLN metastasis the prognosis differed with respect to surgical approaches (group A vs B, P=0.709;group C vs D, P=0.253). Univariate analysis by log-rank test showed that, lymph node metastasis, pathological grade, depth of invasion, and tumor location could significantly affected survival (P<0.05), whereas age, tumor diameter, and surgical approach didn′t (P>0.05). Multivariate analysis showed that lymph node metastasis (RR=21.57, 95%CI:2.68-173.10, P=0.002) and tumor location (RR=7.85, 95%CI:1.79-34.50, P=0.024) were the independent factors for overall survival. Conclusions Lymph node metastasis is an independent prognosis factor for patients with early-stage vulvar cancer. SLNB could accurately diagnose the status of lymph nodes and help to decide subsequent treatment. The omissions of IL in patients with negative SLN avoid surgical morbidity and shorten postoperative recovery period without an increased risk of recurrence.

ObjectiveTo study the dose distribution of the intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) inverse plans with different energy X-ray, to provide a reference of energy options for radiation therapy. MethodsEight cases with different disease were chosen, the plan for each case were finished with 1Arc (360°) VMAT, 9 fields IMRT and 5 fields IMRT.For each plan project, the energy selections were 4 MV, 6 MV, 8 MV and 15 MV. In the evaluation,homogeneity index ( HI), conformity index ( CI ) and external volume index ( EVI ) of target, the average dose ( Dmean) and 2％ volume in dose volume histogram ( D2 ) of serial organs at risk ( OARs), the average dose ( Dmean ) and a dose level volume ( Vx ) of parallel OARs were chosen and compared . Results Statistical analysis showed that: For the target, the result of HI were F=0. 13,0. 51,0. 09, P=0. 939,0.679,0.965,CI were F=0. 13,0.51,0.09,P=0.939,0.679,0.965, EVI were F=0. 15,0.31,0. 15,P =0. 930,0. 818,0. 931, respectively ; For the OARs of each patient, F ＜ 0. 20, P ＞ 0. 05. All results indicated there was little difference in option of energy for the same field p8roject. ConclusionsThe results indicate that the middle and low energy X-ray (6 MV or 8 MV) can satisfy the needs of IMRT and VMAT radiotherapy. Compared with middle and low energy, the high energy X-ray (15 MV ) showed little advantage in dose distribution.

Objective To explore the relationship between angiogenin-1/2 (Ang-1/2) and clinical parameters of idiopathic pulmonary fibrosis (IPF), and to assess the value of Ang-1/2 in predicting the prognosis of patients with IPF.Methods A retrospective analysis was conducted. Ninety-one patients diagnosed as IPF by high resolution CT (HRCT) and lung biopsy admitted to Daqing Oil Field General Hospitalfrom March 2014 to January 2015 were enrolled. The general data, serum parameters and pulmonary function parameters of all patients were collected. After treatment, all of the 91 patients were followed-up to 2 years. The patients were divided into favorable prognosis group and unfavorable prognosis group according to follow-up results. The differences in all parameters between the two groups werecompared. The relationship between Ang-1, Ang-2 and lung function parameters was analyzed by Pearson correlation analysis. Cox proportional hazard regression model was used to evaluate the effect of clinical parameters on the prognosis of patients with IPF. The effect of Ang-2 in predicting prognosis of patients with IPF was analyzed by receiver operating characteristic (ROC) curve.Results During the 2-year follow-up period, 30 of 91 patients showed a favorable prognosis, and 55 showed an unfavorable prognosis with a poor prognosis rate of 64.71%, and 6 patients withdrew from the study due to loss of follow-up and death. Compared with the favorable prognosis group, Ang-2 level in the unfavorable prognosis group was significantly increased (μg/L: 2.88±1.63 vs. 1.89±1.22,t = 2.909,P= 0.005), but Ang-1 only showed a slight increase (μg/L: 28.70±14.26 vs. 25.62±11.95,t = 1.005,P = 0.318). The results of Pearson correlation analysis showed that Ang-2 level was negatively correlated with forced expiratory volume in 1 second (FVC1) and the percentage of carbon monoxide diffusing capacity accounting for the expected value (DLCO%;r value was -0.227 and -0.206, andP value was 0.147 and 0.253, respectively), but no significant correlation between the level of Ang-1 and FVC1 as well as DLCO% was found (r value was -0.153 and -0.121, andP value was 0.147 and 0.253, respectively). Cox proportional hazard regression model analysis showed that the prognosis of patients with IPF was significantly affected by smoking time and Ang-2 (bothP< 0.05), and the influence of Ang-2 was greater [relative risk (RR): 1.236 vs. 1.006, P= 0.037]. Age, gender, smoking and the levels of FVC1, DLCO% and Ang-1 had no significant effect on the prognosis of IPF patients (allP> 0.05). Prognostic analysis showed that the area under ROC curve (AUC) of Ang-2 for predicting prognosis of patients with IPF was 0.692, and the best diagnostic point was 0.35μg/L, the sensitivity was 61.8%, the specificity was 73.3%, the positive predictive value was 69.8%, and the negative predictive value was 65.7% which indicated that Ang-2 could predict the prognosis of patients with IPF.Conclusion Ang-2 could assess the prognosis of patients with IPF, which is expected to be used as an indicator of predicting the prognosis of patients with IPF.

Objective To validate the discriminatory capacity of the new ankylosing spondylitis disease activity scores (ASDAS) in Chinese ankylosing spondylitis (AS) patients, and assess its clinical value. Method One hundred and twenty-nine patients with AS was included in the study, in which 87 were par-ticipat clinical trials with Etanercept (n=87) and 42 were participants of clinical trails with. The disease activity and treatment effecticacy were assessed by ASDAS, BASDAI and patient global assessment. Discriminatory ability of all the measures was analyzed as standardized mean difference (SMD) and (-score. Pearson's correlation, two indepen -dent samples t test and simple linear regression model were used for statistical analysis. Result The four ASDAS scores correlated well with patient global assessment (r=0.56～0.74), ESR (r=0.50～0.80) and CRP (r=0.50～0.69) both at baseline and the changes form baseline to 6 weeks after treatment. The four ASDAS outperformed BASDAI, patient global assessment, ESR and CRP in differentiating patients with different levels of disease activity and patients with different levels of change. There was little difference in performance between the four ASDAS versions. Conclusion The four ASDAS are highly discriminatory in evaluating the disease activity and the efficacy of drugs in Chinese AS patients, showing a significant value in clinical practice.

Forty three medical graduates from Hainan Medical University participating in the standardized general practice residency training in 2015 and 2016 were randomly divided into study group (n=22) and control group (n=21). The study group received a mid-term assessment and formative assessment, and the control group received the final assessment only. At the end of the six months of training, the scores of the mid-term assessment in study group were significantly higher than those in the control group [(82.9±8.4) vs. (75.5±10.2), t=12.706, P<0.01]. A questionnaire survey was conducted among the participants in study group, 86.4% of them recognized and supported the formative assessments. Formative assessment can improve the teaching quality of general practice residency training. The trainees have a positive attitude towards this assessment mode.