OBJECTIVE: To investigate the clinical characteristics of urgent tracheotomy patients. METHOD: Forty-five cases of urgent tracheotomy patients were reviewed retrospectively. The clinical characteristics, pre-operative and post-operative clinical manifestation and complication were studied. Most patients for urgent tracheotomy were head and neck tumor, inflammation and head and neck injury. RESULT: Two patients died in operating and two patients died in post-operation. Finding respiratory depression in six patients of long obstruction in post-operation. Eleven patients had complication in operating or post-operation. Hemorrhage and pneumoderma and local trauma were the main complications. CONCLUSION Emergent tracheotomy and elective tracheotomy were different-in the short operation time and body position. Complication incidence rate were higher than normal tracheotomy. Patients of long obstruction after post-operation shouldn't breathe in pure dephlogisticated air to avoidance respiratory depression.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tracheotomy ; adverse effects ; Young Adult

Objective To analysis the reliability of the examination of Introduction of Nursing by using the methods of generalizability theory and to give advice on how to modify examination paper.Methods Estimation value of variance component from different variations and precision indexes were calculated by applying the principle of generalizability theory.Results The generalizability coefficient and index of dependability were greater than 0.4 in choice question and terminology explanation,the generalizability coefficient of short-answer question was also greater than 0.4.Short-answer question's index of dependability and generalizability coefficient and index of dependability of comprehensive problem were less than 0.4.Conclusions Generalizability theory can be used in analysis the reliability of the examination of Introduction of Nursing.Its result is helpful to improve the framework of examination papers and the reliability of examination.

BACKGROUND: D-galactose-induced aging animal model is similar tohuman natural aging. Whether the expression of protein phosphatase-1(PP-1) in the brain of D-galactose-induced aging mice is related to cerebralaging process or not should be researched further. OBJECTIVE: To investigate the effect of the APP17 peptide and theliquid extract ofjiunao yizhi capsule on regulating the expression of PP-1 inhippocampal neurons of the aging mice induced by the D-galactose (D-gal). DESIGN: A random controlled study. SETTING: Department of Pathology, College of Basic Medical Sciences, Capital University of Medical Sciences and Beijing Research Laboratory forBrain Aging, Xuanwu Hospital of Capital University of Medical Sciences. MATERIALS: The study was completed between July 2003 and July2004 in the Experimental Center of Capital University of Medical Sciences. Forty male Kunming mice (SPF grade) with a body mass fron 28 g to 32 gwere purchased from Chinese Academy of Medical Sciences Institute ofMaterial Medical.METHODS: Kunming mice were randomly divided into 5 groups: control group, D-gal group, APP17 peptide treatment group, low dose herb treatment group, and high dose herb treatment group with 8 mice in each group. In Dgal group, APP17 peptide treatment group, low dose herb treatment group and high dose herb treatment group, galactose was injected subcutaneously (50 nmg/kg). Meanwhile, 0.1 mL normal saline containing 0.35 μg of APP17 peptide was injected subcutaneously into the mice in APP17 peptide treatment group, once a day for 3 months; liquid extract of jiunao yizhi capsule (provided by Beijing Chaoyangmen Hospital and Shanxi Quwo Traditional Medical Institute; the main component: dangshen, baizhu, guijia and chuanshanjia, etc.) was perfused by stomach (0.3 g/kg and 1.0 g/kg respectively) in low dose herb treatment group and high dose herb treatment group, once a day. And equivalent normal saline was injected and perfused in the two control groups. After 3 months of survival, the mice were killed and their brains were cut into sections. The immunohistochemical staining of these sections was then performed with PP-1 antibody.MAIN OUTCOME MEASURES: The results of immunohistochemical staining analysis of PP-1.RESULTS: Forty mice entered the final analysis without any loss. PP-1 positive cells in the hippocampus were poorly stained in the D-gal mice. In contrast, PP-1 positive neurons were widely distributed in the hippocampus of those normal mice, the APP17 peptide-treated D-gal mice and the high liquid extract of raw herb-treated D-gal mice. These cells were darkly stained in cytoplasm. The unexpected result was that in the low liquid extract of raw herb-treated D-gal mice the number of PP-1 positive neurons did not increase to normal.CONCLUSION: The results demonstrated that the expression of PP-1 decreased in the hippocampus of D-gal mice. The APP17 and low dose liquid extract of raw herbs can regulate the distribution of PP-1 in the brain of D-gal mice and make them recover to normal situation.

BACKGROUND: In brain insulin does its work through the insulin receptor substrate (IRS). Amyloid beta protein precursor 17 (APP17) peptide has the neurotrophic function, which may improve diabetic encephalopathy resulted from insulin deficiency by affecting insulin receptor substrate.OBJECTIVE: The mouse diabetic model was produced to observe the effect of APP17 peptide on the distribution of IRS-1 in brain tissues.DESIGN: Randomized control animal experiment.SETTING: Staff Room of Pathology, College of Basic Medical Sciences,Capital University of Medical Sciences; Beijing Research Laboratory for Brain Aging of Xuanwu Hospital.MATERIALS: The experiment was performed in Staff Room of Pathology,College of Basic Medical Sciences, Capital University of Medical Sciences and Beijing Research Laboratory for Brain Aging of Xuanwu Hospital from September to October 2003. Totally 18 male kunming mice were employed,and randomly assigned into control group, diabetic group and APP17 peptide treatment group with 6 mice in each group.METHODS: ①The mice were subjected to intraperitoneal injection of streptozotocin (STZ, Sigma) by 200 mg/kg, and 3 days later, the tail blood was sampled to examine non-fasting blood glucose, and the blood glucose over 15 mmol/L was set as the criteria for successful diabetic model establishment. ②In APP17 + diabetes mellitus group, the mice received subcutaneous injection of 0.35 μg APP17 peptide once daily for 2 weeks. The mice in the normal control group were not interfered. ③Then brain was removed and crystat sections were prepared. Immunohistochemical staining was done for IRS-1 at four weeks after giving streptozotocin.MAIN OUTCOME MEASURES: Pattern and distribution of IRS-1 positive cells of mice in each group.RESULTS: Totally 18 mice were involved in the result analysis. ①In the brains of diabetic mice the IRS-1 immunohistochemical positive cells distributed at cortex, hippocampus, thalamus, hypothalamus and so on, while the positive cells distributed only at cortex and hippocampus in the normal control group and APP17 peptide treatment group, lightly stained. ②Numbers of immunohistochemical positive cells of IRS-1 of cerebral hippocampus in the diabetic group, normal control group and APP17 peptide treatment group were (28.7±1.5), (9.2±1.5), (10.1±1.4) piece per 10 power object lens, and that in the diabetic group was higher than that in the other two groups (P ＜ 0. 001 ). CONCLUSION: Neurons in many regions of brains of diabetic mice have plenty of IRS-1 positive cells. APP17 peptide can make part and quantity of IRS-1 positive cells normality so as to ameliorate the degeneration of hippocampal neurons of diabetic mice.

Objective To investigate the career decision-making self-efficacy as well as the psychological well-being of medical students and to discuss the correlation between them.Methods A cross-sectional survey with cluster random sampling was performed anonymously among 714 students of different majors and different grades in an medical University.The contents of the survey included the career decision making self-efficacy scale (CDMSE) as well as the self-reporting inventory(SCL-90).All data in the two groups were analyzed with t test; comparison of data between groups were analyzed with One-Way ANOVA; multiple comparison was analyzed with S-N-K; Pearson and Partial correlation analysis were used to analyzed the correlation between the career decision making self-efficacy and wellbeing.Results Totally 659 students completed the inventory,with response rate being92.3％.Average score of the participants' career decision-making self-efficacy was (124.72 ± 26.76)points,situating at the middle and lower level.There were differences in the scores of career decision making selfefficacy among different sexes,sources,grades and being student cadres or not (P =0.019,0.000,0.027,0.026) ; No differences was found among students of different majors and whether being the only child(P =0.243,0.223).Results of the SCL-90 inventory demonstrated that medical students had some psychological problems including obsessive-compulsive,interpersonal sensitivity and anxiety.Correlation analysis showed that psychological well-being and career decision-making self-efficacy was negatively correlated.Conclusions Measures should be taken to improve the medical students' career decision-making self-efficacy according to their psychological characteristics and to improve the medical students' psychological status by the improvement of career decision-making self-efficacy.

Objective To investigate the effect of insulin signaling pathway on neuronal survival and the effect of the peptide App17 on regulating the expression of some apoptosis-related proteins in neurons of the hippocampus through intracerebrorentricular injection of streptozotocin in rats. Methods The rats were injected with App17 peptide subcutaneously three weeks after the model group was established by intracerebrorentricular injection of streptozotocin.After the four-week treament,the expressions of the apoptosis-related proteins,such as Bcl-2,Bax,CytoC in neurons of the hippocampus were tested with immunohistochemical staining and Western blotting.Results Bax,CytoC positive neurons were widely distributed in the hippocampus of the model group,and the cytoplasm was darkly stained.In contrast,the positive neurons for Bax,CytoC in hippocampus were poorly stained in the control group and the treated group,and appeared significant difference in cell counting as compared with model group.Bcl-2 positive neurons were widely distributed in the hippocampus in the control group and the treated group,and the cytoplasm was darkly stained while its positive neurons were poorly stained in the model group,and appeared significant difference in cell counting as compared with the model group.From the Western blotting clear bars could be seen in the three groups and there was a significant difference between them.Conclusions The expression of Bax,CytoC increased in the hippocampus in the rats with intracerebrorentricular injection of streptozotocin while the expression of Bcl-2 decreased.The App17 peptide could promote the rehabilitation of the abnormal expression of the three proteins to some extent.The insulin signaling pathway could affect the survival of the neurons in rats' hippocampus.

Objective To investigate the ability level of institutionalized elderly people and its correlation with pension service demand.Methods Ability assessment for older adults and a self-designed questionnaire about pension service demand were used to survey the ability level and service demand of 332elderly people in 7 institutions of Yancheng city in Jiangsu province in July 2014.The influence factors of pension service demand were analyzed by the binary classification Logistic regression.Results 67.8％ (225/332),14.8％(48/332) and 15.7％(52/332) institutionalized elderly's ability level were mild,moderate and severe impairment.The impairment of ability levels of the elderly had positive impact on helping eating,bath,cleaning,medical service and other services agency and negative impact on culture and entertainment.Conclusions The ability of institutionalized elderly were poor in Yancheng city in Jiangsu Province.We should provide service according to their abilities and demand,in order to ensure the rational use of the limited resources.

Objective: To establish the method of determination of the content of Berberine hydrochloride and Palmatine hydrochloride in Wuji Pills. Methods: Ultrasonic extraction, HPLC was used to determine Berberine hydrochloride and Palmatine hydrochloride in Wuji Pills on C 18 Column, using 0.033mol/L KH 2PO 4 CH 3CN(90∶40) as mobile phase, with detection at 265nm. Results: The linearity of this method was well. The average recoveries were 99.07% for Berberine hydrochloride and 98.59% for Palmatine hydrochloride. RSD were 1.3% and 1.7%, respectively. Conclusion: This method shows good separating degree and can be used for quality control of Wuji Pills.

Objective To investigate the effects of different degrees of neuromuscular blockade (NMB) induced by rocuronium on facial nerve evoked-electromyographic (EEMG) monitoring in patients undergoing resection of acoustic neuroma.Methods Thirty-five ASA Ⅰ or Ⅱ patients of both sexes,aged 20-64 yr,with body mass index ≤30 kg/m2,scheduled for elective resection of acoustic neuroma under general anesthesia,were included in the study.Anesthesia was induced with midazolam,fentanyl and propofol.The patients were mechanically ventilated after tracheal intubation.Facial nerve EEMG monitoring and peripheral NMB monitoring were performed simultaneously during operation.Facial nerve EEMG was monitored using the Epoch XP2000 multichannel electrophysiological nerve monitoring system (Axon Co.,USA),facial nerve was stimulated and evoked potential of orbicularis oculi was recorded during operation.Peripheral NMB degrees were monitored with TOF-Watch SX monitor (Organon Co.Holland).After rocuronium 0.6 mg/kg was injected intravenously,the facial nerve EEMG responses were monitored when the degree of NMB (T1) was at 100％,75％,50％,25％ and 0 of the control height.The amplitude and latency of EEMG were recorded.The amplitude reservation ratio (the ratio of the amplitude of EEMG monitored to the baseline value) was calculated.Linear correlation of the amplitude reservation ratio or latency of EEMG with the degree of NMB was analyzed.Results No EEMG response was elicited when the degree of NMB was 100％ in 6 patients.The lirear regression equation of the interaction between the degree of NMB (X) and the amplitude reservation ratio (Y) was Y =1 - 0.787 X,the coefficient of determination was 0.898 ( P ＜ 0.05) and the correlation coefficient was - 0.947 ( P ＜ 0.05).The correlation coefficient between the latency of EEMG and the degree of NMB was 0.328 ( P ＜ 0.05).Conclusion When the degree of NMB is maintained at 25 ％-50％,facial nerve EEMG can be monitored effectively and body movement can be avoided during resection of acoustic neuroma.

Objective To evaluate the effect of penehyclidine hydrochloride on the damage to the non-ventilated lung in the pediatric patients undergoing one-lung ventilation (OLV).Methods One hundred and twenty pediatric patients of both sexes,aged 2-6 yr,with body mass index of 17-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or lⅡ and New York Heart Association class Ⅰ or Ⅱ,undergoing elective lobectomy performed via video-assisted thoracoscope,were randomly divided into 2 groups (n=60 each) using a random number table:control group (group C) and penehyclidine hydrochloride group (group P).At 10 rmin before anesthesia induction,penehyclidine hydrochloride 0.05 mg/kg was injected intravenously in group P,and the equal volume of normal saline was given in group C.At 5 min after drug intervention (T0),immediately after onset of OLV (T1),at 60 min of OLV (T2),immediately after the end of OLV (T3),at the end of surgery (T4),and at 24 h after surgery (T5),venous blood samples were collected for determination of serum tumor necrosis factor-alpha (TNF-o),interleukin-6 (IL-6) and IL-8 concentrations by enzyme-linked immunosorbent assay.The specimens of normal lung tissues around the lung lobe to be resected were obtained at T1 and T3 for determination of the injured alveolus count (with a light microscope) and cell apoptosis (using TUNEL) and for examination of the ultrastructure of epithelial cells (with a transmission electron microscope).The injured alveolus rate (IAR) and apoptosis index (AI) were calculated.Results Compared to the value at T0,the IAR and AI were significantly increased at T3,the serum TNF-α,IL-6 and IL-8 concentrations were significantly increased at T2-5 (P＜0.05),and the pathological changes were obvious in the two groups.Compared to group C,the IAR and AI were significantly decreased at T3,the serum TNF-α,IL-6 and IL-8 concentrations were significantly decreased at T2-5 (P＜0.05),and the pathological changes were significantly reduced in group P.Conclusion Penehyclidine hydrochloride can attenuate the damage to the non-ventilated lung in the pediatric patients undergoing OLV,and the mechanism is probably related to inhibition of systemic inflammatory responses and cell apoptosis in lung tissues.