Objective To understand the current status of aloneness and analyze the influencing factors,and to provide reference to improve the aloneness among middle?aged and elderly. Methods A total of 994 middle?aged and elderly in Donggang sampled by stratified random sampling method were investigated by UCLA scale. The influencing factors were assessed by t?test and one?way ANOVA. The data were analyzed by SPSS 16.0. Results The average score of UCLA scale among middle?aged and elderly was 41.54 ± 8.91. The results indicated whether living with their children,alcohol drinking,quality of sleep,history of trauma,psychological counseling,monthly income,chronic disease and physical training were the influencing factors of aloneness among middle?aged and elderly,and the differences were statistically significant(P<0.05). Conclusion The aloneness was obvious among middle?aged and elderly in China. Health interventions and effective social support should be provided to improve the physiological,psychological and economic levels that will lead to important influence on the improvement of aloneness among middle?aged and elder?ly in China.

The computer-based case simulation is a method of medical exam which can test students to solve the clinical ability,in particular the clinical policy-making thought and it is one of important methods of solving patient problem ability.This article is to introduce concept,the development as well as scoring method.It also expounds the superiority of the computer-based case simulation and shortcoming of the scoring method to provide the warrenty for the application in the nation-wide range in future.

The aim of the research is to study the prevalence and antimicrobial resistance of Campylabocter jejuni isolated from poultry in Jiangsu Province.A total of 753 samples from poultry meat and cloacal swabs were investigated,after the pure culture and the polymerase chain reaction of the mapA gene,207 isolates were examined for antimicrobial resistance by using K-B method according to World Health Organization.Results showed that all isolates performed different degree of antimicrobial resistance except meropenem,gentamycin,kanamycin,florfenicol and fosfomycin,the resistance rates of 194 strains to trimethoprim,norfloxacin,ceftriaxone and tetracycline were 100％,84.02％,80.9％ and 79.4％ respectively,1 strain isolated from Xuzhou was resistant to 92.6 ％ antibiotics.The multi-drug resistance appeared and the advantage of drug-resistant spectrum was LIN/CTX/CRO/NOR/CIP/T/TE,the resistant type focused on 40％-60％.The research provided evidence for surveillance of the antimicrobial resistance of C.jejuni and highlighted the need to employ more prudent use of critically important antimicrobial.

To ensure the quality of building basic test bank and to effectively measure the quality of medical exam questions,now,we analyze the problems of the basic test papers from 13 north medical universities in many aspects such as cognitive rank,difficulty,conformity and core content etc.Having found the main problems of the testing papers,we supply the viewpoint for improvement and make better foundation for the construction of test bank.

This paper gives the statistical analysis on the examination of Computer-Based Case Simulation to test 350 undergraduate clinical medical students of 5th or 6th year students,and analyses the statistical items of examination,then gives some discussion and reasonable suggestions.Finally,the author makes a series of discussion and views in the application of the medical education evaluations in future.

As muscle activity during growth is considerably important for mandible quality and morphology,reducing dietary loading directly influences the development and metabolic activity of mandibular condylar cartilage (MCC).However,an overall investigation of changes in the protein composition of MCC has not been fully described in literature.To study the protein expression and putative signaling in vivo,we evaluated the structural changes of MCC and differentially expressed proteins induced by reducing functional loading in rat MCC at developmental stages.Isobaric tag for relative and absolute quantitation-based 2D nano-high performance liquid chromatography (HPLC) and matrix-assisted laser desorption/ionization time-of-flight/ time-of-flight (MALDI-TOF/TOF) technologies were used.Global protein profiling,KEGG and PANTHER pathways,and functional categories were analyzed.Consequently,histological and tartrate-resistant acid phosphatase staining indicated the altered histological structure of condylar cartilage and increased bone remodeling activity in hard-diet group.A total of 805 differentially expressed proteins were then identified.GO analysis revealed a significant number of proteins involved in the metabolic process,cellular process,biological regulation,localization,developmental process,and response to stimulus.KEGG pathway analysis also suggested that these proteins participated in various signaling pathways,including calcium signaling pathway,gap junction,ErbB signaling pathway,and mitogen-activated protein kinase signaling pathway.Collagen types Ⅰ and Ⅱ were further validated by immunohistochemical staining and Western blot analysis.Taken together,the present study provides an insight into the molecular mechanism of regulating condylar growth and remodeling induced by reducing dietary loading at the protein level.

Objective:To evaluate the effect of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) on reflux and micro-aspiration during induction of general anesthesia in the patients undergoing laparoscopic cholecystectomy.Methods:A total of 60 patients, regardless of gender, aged 18-60 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=30 each) using a random number table method: routine mask ventilation group (group C) and trans-nasal humidified rapid insufflation ventilatory exchange group (group H). Patients in group C were pre-oxygenated with a mask for 5 min, oxygen flow of 6 L/min and FiO 2 100%, after the induction of anesthesia, the pressure mask was used to artificially assist positive pressure ventilation for 2 min when the patient′s consciousness disappeared, and 2 min later endotracheal intubation was performed.Patients in group H were pre-oxygenated with THRIVE for 5 min, oxygen flow of 30 L/min and FiO 2 100%.The oxygen flow was increased to 50 L/min during anesthesia induction.After anesthesia induction, the oxygen flow was increased to 70 L/min when the patient′s consciousness disappeared, and chin lift and/or jaw thrust was used during apnoea to maintain an open airway, the patient′s mouth was kept closed during the whole process, and 2 min later endotracheal intubation was performed.Ultrasound was used to measure the cross-sectional area (CSA) of the gastric antrum and to monitor the occurrence of gastric insufflation, and the incidence of CSA greater than >3.4 cm 2 was recorded on admission to the operating room and immediately after tracheal intubation.Supraglottic and subglottic secretions were collected at the time of tracheal intubation using visual laryngoscopy after exposing the glottis, and the pepsin content was determined using enzyme-linked immunosorbent assay to assess reflux (content of pepsin in supraglottic secretion >216 ng/ml) and micro-aspiration (content of pepsinin subglottic secretion >200 ng/ml), and arterial blood gas analysis was simultaneously performed.The apnoea time was recorded, and P ETCO 2 at the first mechanical ventilation after tracheal intubation were recorded. Results:Compared with group C, PaO 2 was significantly increased and CSA was decreased immediately after tracheal intubation, and the incidence of CSA greater than >3.4 cm 2 immediately after tracheal intubation was decreased, and the incidence of gastric insufflation, reflux and micro-spiration was decreased, apnoea time was prolonged, and P ETCO 2 at first mechanical ventilation was increased in group H ( P<0.05). Conclusions:THRIVE applied during induction of general anesthesia can reduce the occurrence of reflux and micro-aspiration while ensuring oxygenation in the patients undergoing laparoscopic cholecystectomy.

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pulmonary function in the patients undergoing robot-assisted radical resection of colon cancer.Method:Ninety-four patients of either sex, aged 50-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with ARISCAT grade of medium risk, undergoing elective robot-assisted radical resection of colon cancer, were enrolled in this study. The patients were divided into TEAS group (group T, n=47) and sham-TEAS group (group S, n=47) using a random number table method. In group T, patients received 30 min of TEAS at Hegu (LI4), Quchi (LI11), Zusanli (ST36) and Feishu (BL13) between 5: 00 and 7: 00 a. m. from 1st day before operation to 3rd day after operation, with disperse-dense wave 2/100 Hz, and the stimulation intensity was the maximum intensity that the patient could tolerate. Patients in group S were also connected to the device without electrical stimulation. Both groups adopted lung-protective ventilation strategy during operation. The oxygenation index was calculated at the time of entering the operating room (T 0), 5 min after anesthesia induction (T 1), 5 min of pneumoperitoneum (T 2), 5 min after changing to Trendelenburg position (T 3) and immediately after the end of pneumoperitoneum (T 4). Peak airway pressure, plateau airway pressure, driving pressure and dynamic lung compliance were recorded at T 0-T 4. The serum concentration of lung Clara cell 16 kDa protein was recorded using enzyme-linked immunosorbent assay at T 0, T 4 and 2 h after extubation (T 5). On 1 day before operation and 1, 3 and 7 days after operation, the forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured, and the FEV 1/FVC was calculated, and the concentrations of serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation were simultaneously determined using enzyme-linked immunosorbent assay. The occurrence of pulmonary complications within 7 days after operation was recorded. Results:There was no significant difference in pH values, PaCO 2, oxygenation index, peak airway pressure, plateau airway pressure, driving pressure, and dynamic lung compliance at each time point between the two groups ( P>0.05). Compared with S group, the serum Clara cell 16 kDa protein concentrations were significantly decreased at T 5, FEV 1 and FVC were increased at 3 and 7 days after operation, the serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation concentrations were decreased at 1, 3 and 7 days after operation, the incidence of unexpected oxygen supply and total incidence of postoperative pulmonary complications were decreased ( P<0.05), and no significant change was found in FEV 1/FVC at each time point in T group ( P>0.05). Conclusions:TEAS can improve lung function in the patients undergoing robot-assisted radical resection of colon cancer.

Objective:To evaluate the effect of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) on regional cerebral oxygen saturation (rScO 2) during induction of general anesthesia in patients undergoing traumatic brain injury (TBI) emergency surgery. Methods:A prospective randomized controlled trial was conducted. The TBI emergency general anesthesia patients who underwent intracranial hematoma removal surgery at the Northern Jiangsu People's Hospital from January to July in 2023 were enrolled. The patients were divided into a conventional mask ventilation group and a THRIVE group using a random number table method. The patients in the conventional mask ventilation group were anesthetized and induced to pre oxygenate without positive pressure ventilation in the front mask for 10 minutes, with an oxygen flow rate of 8 L/min and an fraction of inspired oxygen (FiO 2) of 1.00. After anesthesia induction for about 90 s, tracheal intubation was performed after the muscle relaxant took effect (patient's jaw muscle was relaxed). The patients in the THRIVE group were pre oxygenated with THRIVE for 10 minutes, with an oxygen flow rate of 30 L/min and a FiO 2 of 1.00. During anesthesia induction, the oxygen flow rate was increased to 50 L/min, and anesthesia induction medication was used. The lower jaw of patient was supported with both hands to maintain airway patency, and the patient's mouth was kept closed throughout the process. After the muscle relaxant took effect (the patient's jaw muscle was relaxed), tracheal intubation was performed. At the time of patient entering the operating room, 10 minutes of pre oxygenation, and immediately after successful intubation, rScO 2 was measured on the surgical and non-surgical sides. At the same time, ultrasound was used to measure the cross-sectional area (CSA) of the gastric antrum and arterial blood gas analysis was performed. The partial pressure of end-tidal carbon dioxide (P ETCO 2) during the first mechanical ventilation after successful tracheal intubation, the incidence of hypoxemia [pulse oxygen saturation (SpO 2) < 0.95] during tracheal intubation, as well as prognostic indicators such as the length of intensive care unit (ICU) stay, total length of hospital stay, and Glasgow outcome scale (GOS) score at discharge were recorded. Results:During the study period, a total of 70 TBI patients underwent emergency general anesthesia surgery, of which 2 patients died postoperatively, 2 patients were unable to cooperate with closed mouth breathing, and 3 patients had poor ultrasound image acquisition in the gastric antrum, all of whom were excluded. A total of 63 patients were ultimately enrolled, including 32 in the conventional mask ventilation group and 31 in the THRIVE group. There were no statistically significant differences in gender, age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, Glasgow coma scale (GCS) score, optic nerve sheath diameter (ONSD), baseline vital signs, fasting situation, anesthesia time, surgical time, and intraoperative blood loss between the patients in the two groups, indicating comparability. When entering the operating room, there was no statistically significant difference in rScO 2 on the surgical and non-surgical sides, and blood gas analysis indexes arterial partial pressure of oxygen (PaO 2) and arterial partial pressure of carbon dioxide (PaCO 2) between the patients in the two groups. When pre oxygenated for 10 minutes, both the surgical and non-surgical sides rScO 2 levels in the THRIVE group were significantly higher than those in the conventional mask ventilation group (surgical side: 0.709±0.036 vs. 0.636±0.028, non-surgical side: 0.791±0.016 vs. 0.712±0.027, both P < 0.01), and the PaO 2 was significantly increased [mmHg (1 mmHg≈0.133 kPa): 450.23±60.99 vs. 264.88±49.33, P < 0.01], PaCO 2 was significantly reduced (mmHg: 37.81±3.65 vs. 43.59±3.76, P < 0.01), and the advantage continues tilled immediately after successful intubation. There was no statistically significant difference in CSA at each time point of ultrasound examination between the two groups. Compared with the conventional mask ventilation group, the patients in the THRIVE group showed a significant decrease in P ETCO 2 during the first mechanical ventilation after successful tracheal intubation (mmHg: 43.10±2.66 vs. 49.22±3.31, P < 0.01), and the incidence of hypoxemia during tracheal intubation was also significantly reduced [0% (0/31) vs. 28.12% (9/32), P < 0.01]. In terms of prognostic indicators, there was no statistically significant difference in the length of ICU stay and total length of hospital stay between the patients in the conventional mask ventilation group and the THRIVE group [length of ICU stay (days): 10 (9, 10) vs. 10 (9, 11), total length of hospital stay (days): 28.00 (26.00, 28.75) vs. 28.00 (27.00, 29.00), both P > 0.05]. However, the proportion of patients in the THRIVE group with a good prognosis at discharge (GOS score > 3) was significantly higher than that in the conventional mask ventilation group [35.5% (11/31) vs. 12.5% (4/32), P < 0.05]. Conclusion:THRIVE can significantly increase rScO 2 during anesthesia induction in TBI emergency surgery patients and improve their neurological function prognosis.

OBJECTIVE: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). MATERIALS AND METHODS: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. RESULTS: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). CONCLUSION: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.
Collateral Circulation ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity