Objective To evaluate the efficacy of the nasopharyngeal airway for airway management during anesthesia recovery in obese patients. Methods Eighty ASA Ⅰ-Ⅲ patients, aged 48-72 yr, body mass index > 30 kg/m~2 , were randomly divided into 2 groups (n=40 each) : nasopharyngeal airway group (group Ⅰ) and oropharyngeal airway group (group Ⅱ). The extubation was performed after recovery of breathing (RR ≥ 10 bpm, V_T≥5 ml/kg). The nasopharyngeal airway was inserted though the nasal cavity immediately after extnhation in group Ⅰ, and the oropharyngeal airway was inserted though the oral cavity after extubation in group Ⅱ. Oxygen (3 L/min) was then inhaled by mask until recovery of consciousness in both groups, and if SpO_2 < 90%, the rescue medication was given. The changes in RR, SpO_2 , HR, SP and DP were observed at 1 min (T_1), 5 min (T_2), 10 min (T_3) and 20 min (T_4) after insertion of the airway and complications were recorded in 20 min after insertion of the airway. Results The RR, SpO_2, HR, SP and DP were all maintained in the normal range after insertion of the airway in both groups. The RR,HR, SP and DP at T_(3,4) and incidence of resdessness, nausea and vomiting, and laryngospasm were significantly lower in group Ⅰ than in group Ⅱ (P<0.05), while there was no significant difference in SpO_2 at each time point between group Ⅰ and group Ⅱ(P>0.05). Conclusion The efficacy of the nasopharyngeal airway is similar to that of the oropharyngeal airway for the relief of the upper respiratory tract obstruction during anesthesia recovery in obese patients, but the stress response induced is lower and complications are fewer.

Objective To observe the role of brain-derived neurotrophic factor (BDNF) in the plasticity of enteric nervous-smooth muscle system,and to investigate the effects of BDNF induced plasticity on gastrointestinal motility in mice.Methods Male hybrid BDNF knockout (BDNF+/) mice and wild type (BDNF+/+) mice were selected,eight in each group.Gastrointestinal motility of BDNF+/+ mice and BDNF+/ mice were tested and compared.Longitudinal muscle strips of mice colon smooth muscle were prepared.The effects of carbachol (1 × 10 5 mol/L) and BDNF (1 × 10 7 mol/L) on contractile function of muscle strips were observed.And the effects of tetrodotoxin (TTX,1 × 10-6 mol/L) on BDNF induced contractile function of muscle strips were also studied.The changes of the density of mice intestinal myenteric plexus and the expression of smooth muscle α-actin (α-SMA) in colon smooth muscle were detected by immunohistochemical techniqne.The ultrastruetural alterations of myenteric plexus,neuromuscular junction (NMJ) and smooth muscle cells were detected by transmission electron microscope (TEM).T-test or Rank sum test was performed for comparison between groups.Results Number of feces particles and water content in feces of BDNF+/-mice ((3.80±0.75) and (39.60±1.47)％) were both lower than those of BDNF+/+ mice ((6.30± 1.03) and (51.00± 1.61) ％),and the differences were statistically significant (t=4.792,12.827;both P＜0.05).Carbachol (1 × 10-5 mol/L) could significantly increase contraction activity of smooth muscle of BDNF+/+ mice (R =3.26 ± 0.43) and BDNF+/-mice (R=2.15 ± 0.36),and the difference was statistically significant (t=15.754,9.632;both P＜0.05).The effects on contraction exciting of smooth muscle strips of BDNF+/+ mice were more significant than BDNF+/ mice,and the difference was statistically significant (t =5.972,P＜0.05).BDNF could significantly increase contraction of muscle strips of BDNF+/+ mice and R value increased from 1 to 1.41±0.09,and the differences were statistically significant (t=13.674,P＜0.05).TTX could obviously inhibit the excitatory effects of BDNF,R value decreased from 1.41 ± 0.09 to 1.03 ± 0.04 (t=11.692,P＜0.05).The density of myenteric plexus of BDNF+/ mice (median 5.8％,interquartile range 4.2％-7.0％) was significantly lower than that of BDNF+/+ mice (median 9.0％,interquartile range 7.1％-10.8％),and the difference was statistically significant (Z =3.730,P＜ 0.05).The expression of α-SMA of BDNF+/-mice (median 33.4％,interquartile range 28.8％-38.5％) was significantly lower than that of BDNF+/+ mice (median 44.6％,interquartile range 39.2％-48.8％),and the difference was statistically significant (Z=4.565,P＜0.05).The results of TEM indicated ultrastructural alterations of myenteric plexus,NMJ and smooth muscle in BDNF+/-mice.Conelusionss BDNF could induce the plasticity of morphology and function in enteric nervous-smooth muscle system,which may play an important role in mice gastrointestinal motility.

The article discusses how to innovate in the departmental rotation examination for the students practicing in hospital in the new time.It is important for the teacher to provide guidance to students and motivate them to take part in comprehensive training of competence actively so as to cultivate the high-level medical students adaptive to the modern society.

Humanistic spirit advocates the concern for human,and the medical value of people foremost.Now status quo of oral medical students' humanities concern is worrying.This paper aims to analyze the reason,and the best way to culture oral medical students' humanities concern is not only to have an aim of training medical professionals who have oral medical knowledge and skills,but also to look upon the education of medical humanistic spirit as important educative content,to improve teachers' humanities diathesis,to enhance the contact between medical students' and society or patients,to foster affection,to train skills,and to establish the good environment of humanities education.

Objective To investigate the relationship between the bacterial vaginosis and 8 putative periodontal pathogen infection.Methods A total of 48 patients with bacterial vaginosis were collected and 47 healthy female patients were selectedin the control group.Vaginal secretion and subgingival plaque were obtained from the study group and the control group.The presence of Porphyromonasgingivalis (P.g),Tannerella forsythia (T.f),Treponemas denticola (T.d),Prevotell intermedia (P.i),Prevotella nigrescen (P.n),Peptostreptococcus micros (P.m),Fusobacteriumnucleatum (F.n) and Campylobacterrectas (C.r) was detected by DNA extraction and PCR method.Simultaneously,all the patients underwent a clinical periodontal examination of the teeth in community periodontal index,including plaque index (PLI),bleeding on probing (BOP),probing depth (PD) and clinical attachment loss (CAL) Results The prevalence of periodontal disease,PLI,BOP and CAL in the study group was significantly higher than in the control group (P＜0.05) and the PD had no statistically significant difference between the 2 groups (P＞O.05).The 2 groups were both detected 8 putative periodontal pathogens in the vaginal secretion and the subgingival plaque samples.The detection ratio of T.dfrom both the vaginal secretion and subgingival plaque samples was significantly higher in the study group than that in the control group (P ＜0.05),and other 7 pathogens showed no statistically significant difference (P ＞0.05) Conclusion The prevalence of periodontal disease was higher among the bacterial vaginosis patients.The 8 putative periodontal pathogens were normal flora in the subgingival plaque and vaginal secretion.Td might be relevant to the pathogenesis of bacterial vaginosis.

Objective Probing into the changes of medical expenses by medical institutions for references to harnessing such expenses.Methods By means of the time sequence method,analyzing the dynamic changes of medical expenses of district of Beijing from 2004 to 2007,with a comparison for hospitals by levels.Results The study found that between 2004 and 2007,the medical expense per person of outpatients in 26 hospitals fell from 72.73 yuan to 70.09,with a relative ratio with a fixed base being-3.64%;the hospitalization expense per capital rose to 3044.35 yuan,with the same ratio being 13.15%;the percentage of pharmaceuticals sales among total income fell from 40.56% to 40.03%.Conclusions It is feasible to harness the rapid growth of medical expenses by means of normalizing medical charges,restricting the percentage of pharmaceuticals among total expense,improving hospital services at all levels,and promoting health education and health itself.

Objective To clone the gene encoding protein of EspA and Stx2B from EHEC OI57:H7 by DNA recombinant technology, construct prokaryotic expression vector pET-28a ( + )-espAstx2B, express fusion protein of EspA-Stx2B and to analyze the biological and immunological characteristics of the fusion protein. Methods the sequence encoding the protein of EspA and Stx2B was amplified by PCR from the enterohemorrhagic Escherichia coli strain. The amplified products were connected with linker by recombinant technology and cloned into pET-28a( + ) vector. The vector was then transferred to the host cells E. Coli BL21 strain (DE3). Following, the protein expression was induced by IPTG. The expression quantities and style of fusion protein was then determined by SDS-PAGE. Its immunoreactivity was analyzed by Western blot. Finally, BALB/c mice were injected with the preliminarily purified recombination protein EspA-Stx2B, then oral challenged these mice with EHEC O157-SMR2 and counteracted toxic substances with O157 ultrasonic supernatant. Results The determination of the sequence encoding of the espA-stx2B fusion gene has 100% of consistency with the sequence from GenBank Sakai strain and contrivable linker. This fusion protein EspA-Stx2B was expressed as inclusion body formation and the percentage is approximately 40%. Western blot suggested the fusion protein has excellent immunoreactivity. Titer of antiserum of the mice to EspA-Stx2B increased evidently. EspA-Stx2B could not decrease bacterial number attached to the intestinal tract of mice based on fecal shedding of Oi57 in mice. In the test of death of BAI,B/c causing by conteracting toxic substances with O157 ultrasonic supernatant, immunoprotection of EspA-Stx2B rate was 66.7%. Conclusion A recombinant plasmid that has high performance on expression of EspA-Stx2B prorein was successfully constructed in present study, and the fusion protein has excellent immunoreactivity and immunogenicity. EspA-Stx2B could not decrease bacteria] number attached to the intestinal tract of mice based on fecal shedding of O157 in mice, but evidently decrease the mortality rate of the mice. The antiEspA and anti-Stx2B had immunoprotection effect by different means. These results may provide the foundation for the further development on EHEC O157:H7 double subunit vaccine.

Objective To evaluate the diagnostic value of esomeprazole test in patients with gastroesophageal reflux disease.Methods Consecutive patients with heartburn and/or acid regurgitation in three medical centers were enrolled in a prospective,randomized,double-blind study with a placebo-control design.After upper endoscopy examination,patients were divided into non-erosive reflux diseases and erosive esophagitis.All patients underwent 24-hour ambulatory esophageal pH monitoring.Those who were diagnosed as gastroesophageal reflux diseases had either esophagitis under endoscopy or abnormal esophageal acid exposure in 24-hour ambulatory esophageal pH monitoring.The patients were randomly divided into treatment group and control group.The patients in treatment group were received 40 mg of esomeprazole daily while the patients in control group were given placebo once daily for 14 days.The severity and frequency of heartburn were recorded both by doctors and patients before and during treatment.Results Two hundred and seventeen patients were completed the study(105 patients in treatment group and 112 patients in control group).If the symptom of heartburn which disappeared in the sixth and seventh day of the first week,it was defined as positive for esomeprazole test,the sensitivity and specificity in treatment group were 87.7% and 42.5%,respectively If the symptom of heartburn disap peared in the second week,it was defined as positive for esomeprazole test.The corresponding sensitivity and specificity in treatment group were 84.6% and 45%,respectively.The Youden index was 0.362 and 0.296 for criteria of one and two weeks,respectively.If the heartburn score improved by more than 50%,75% or 100% from the baseline score after treatment,it was defined as positive for esomeprazole test,the sensitivity and specificity were 95.4% and 32.5%,87.7% and 32.5%,84.6% and 45%,respectively.Conclusions The esomeprazole test has high value in diagnosis of GERD with sensitivity of 87.7% and specificity of 42.5%.Positive definition of heartburn disappeared in the sixth and seventh day is superior in cost-effective.

Objective To evaluate the clinical value of tomography ultrasonic imaging (TUI) in staging carcinomas of the cervix.Methods Eighty-seven patients with biopsy proven cervical cancer who underwent transvaginal TUI examination were enrolled.Clinical and ultrasonic staging were based on the FIGO staging system.Surgical-pathological or MR results was taken as golden standard.Ultrasonic staging were compared with clinical staging.Tumor sizes of 38 cases of cervical cancers measured by TUI were recorded and compared with the pathological results.Results The overall accuracy of preoperative TUI staging was higher than that of preoperative clinical staging (91.95 ％ vs 81.60 ％,P ＜0.01).Mean size of the 38 malignant tumors was 2.5 cm×2.1 cm×2.2 cm by TUI and 2.6 cm×2.1 cm×2.3 cm by pathological samples (P ＞ 0.05).Conclusions TUI technology may be useful in the noninvasive examination of preoperative staging of carcinoma cervix.

Objective To study the practicability of measurement of abdominal wall tension (AWT) for noninvasive monitoring of intra-abdominal pressure in ICU patients.Methods Patients with indwelling urethral catheter admitted to ICU from April 2011 to March 2013 were enrolled for a prospective study.Exclusion criteria were patients with muscular relaxants,abdominal operation in three months,acute peritonitis,abdominal mass,acute injury of urinary bladder,acute cystitis,neurogenic bladder,intrapelvis hematoma,and pelvic fracture.The AWT (N/mm) and urinary bladder pressure (UBP) (mm Hg) of all patients were measured.Statistical analysis was performed by SPSS 13.0 statistical software.The correlation of AWT and UBP were analyzed using linear regression analysis.The effects of respiration and body position on AWT were analyzed using the Paired-samples t test,and the effects of gender and body mass index (BMI) on basic level of AWT (IAP ＜ 12 mm Hg) were analyzed using the One-way ANOVA.Results A total of 51 patients were recruited in study.A significantly linear correlation between AWT and UBP were observed (R =0.986,P ＜ 0.01),the regression equation was Y =1.369 + 9.57X (P ＜ 0.01).Under the supine-flat positioning,the intra-abdominal pressures at the end of inspiration and the end of expiration were (1.65 ± 0.52) N/mm and (1.45 ± 0.54) N/mm,respectively,and under body straight up 30° supine positioning,the intra-abdominal pressures at the end of inspiration and the end of expiration were (1.25 ± 0.30) N/mm and (1.07 ± 0.35) N/mm,respectively.There were significant differences in intra-abdominal pressure between different respiratory phases and body positions (P ＜ 0.01).Basic levels of AWT in male and female were (1.09 ± 0.29) N/mm and (1.01 ± 0.34) N/mm.The basic levels of AWT in patients with BMI ＜ 18.5,18.5 ≤ BMI ≤25 and BMI ＞ 25 were (0.91 ± 0.30) N/mm,(1.02 ±0.35) N/mm and (1.16 ±0.28) N/mm respectively,but gender and BMI had no significant effects on basic level of AWT (P =0.457 and 0.313,respectively).Conclusions There was a significantly linear correlation between AWT and UBP,and respiratory phase and body position had significant effects on AWT,but gender and BMI had no significant impacts on basic level of AWT.AWT could be served as a simple,easy,and accurate method to monitor the IAP in critical ill patients.