normal group, and the difference of bone mineral density was significant between two groups with lumbar spines and trochanter (P 0.05).③Osteoporosis grouping: The risk factors of osteoporosis may be found only in BMI between the two groups, and the difference was statistically significant (P

Humans ; Pancreatitis, Acute Necrotizing ; diagnosis ; therapy ; Practice Guidelines as Topic

Objective To assess the effects of different doses of oxycodone hydrochloride on spontaneous breathing and consciousness level of patients,so as to provide theoretical basis for its clinical application.Sixty patients undergoing elective surgery were randomly divided into 3 groups:0.05 mg · kg-1 oxycodone group (group P1),0.1 mg· kg-1 oxycodone group (group P2),0.2 mg· kg-1 oxycodone group (group P3).Changes of respiratory rate (RR),end tidal carbon dioxide partial pressure (PETCO2),saturation of blood oxygen (SpO2) and bispectral index (BIS) were recorded in patients before injection (t0) and 1-15 min after injection (once per min);the Observer's Assessment of Alertness/Sedation Scale (OAA/S) were recorded.At the same time,the adverse reactions were observed after drug injection in each group.Results In 10 min after injection there were no significant differences in the RR,SpO2,PETCO2,BIS and OAA/S in group P1 as compared with those before injection (P＞0.05).The patients had no respiratory depression in group P1.In group P2,RR had a significant decrease (P＜0.05),BIS had decreased but were greater than 85;there were no significant differences in the SpO2,PETCO2 and OAA/S (P＞0.05).The P2 group had 3 cases with respiratory frequency＜10 per min,but SpO2 were all greater than 94％.In group P3,There were significant differences in the RR,SpO2,PETCO2,BIS and OAA/S (P＜0.05).The P3 group had 12 cases of respiratory frequency ＜10 per min,at the same time there were 8 patients with SpO2 less than 94％.With the increasing dose,the frequency of respiratory inhibition increased,and there were statistical differences (P＜ 0.05).In 15 min after injection,RR,SpO2,PETCO2,BIS and OAA/S were not significantly different in group P1 and P2 as compared with those before injection (P＞0.05).In group P3,RR was significantly different after injection (P＜0.05).There were no significant differences in the SpO2,PETCO2,BIS and OAA/S in group P3 after injection (P＞0.05).No patients complained with chest wall stiffness,nausea and vomiting,cough and other adverse reactions in group P 1 and P2.In group P3,three patients had nausea 5 min after injection,two patients complained of chest skin itching but no skin flushing.Conclusion With the increasing dose,effect of oxycodone hydrochloride on breathing and consciousness level of patients gradually increased.Injection of oxycodone hydrochloride 0.05 mg · kg-1 had no obvious effect on breathing and consciousness.After injection of oxycodone hydrochloride 0.1 and 0.2 mg · kg-1 for 5 to 10 min,respiration inhibition and sedative effect were the most obvious.Fifteen min after injection,the 0.1 mg · kg-1 dose group recovered to the level before,the respiratory rate of the 0.2 mg · kg-1 dose group was still lower than that before the injection.

Ethics committee in hospitals aims to protect the rights of human subjects and patients,and provide ethical evaluation and justification for guaranteeing the quality of medical research and treatment.Based on experiences in recent years,this paper suggests the following methods in order to manage the activities of ethics committees and push its further development,such as to draft the ethics system,establish the criteria of ethics,implement the process administration and provide ethics training.

Coronary Disease ; etiology ; psychology ; Humans

Objective To compare the lateral decubitus and supine position in the treatment of femoral intertrochanteric fractures with femoral proximal nail antirotation (PFNA).Methods A retrospective analysis was performed of the 85 patients with intertrochanteric fracture who had been treated at our hospital between September 2013 and September 2014.They were 24 men and 61 women,28 to 99 years of age (average,78.5 years).By Evans-Jensen classification,one case was type Ⅰ,15 cases were type Ⅱ,40 type Ⅲ,23 type Ⅳ,and 6 type Ⅴ.All the patients were treated with internal fixation with PFNA.Lateral decubitus position was adopted in 45 cases and supine position in 40.The 2 groups were compared in terms of operation time,intraoperative bleeding volume,difference between preoperative and postoperative hemoglobin values,tip-apex distance (TAD),calcar tip-apex distance (Cal-TAD),fracture healing time,and Harris score of the hip joint.Results The 85 patients were followed up for 9 to 21 months (average,13.6 months).Both 2 groups obtained fracture healing,with no screw cut-out.The lateral decubitus group had significantly less operation time (60.3 ± 17.5 min) and intraoperative bleeding volume (70.8 ± 37.8 mL) than the supine position group (72.7 ± 19.7 min and 90.3 ± 20.9 mL,respectively) (P ＜ 0.05).The former also had a significantly smaller difference between preoperative and postoperative hemoglobin values (24.1 ± 5.7 g/L) than the latter (28.2 ± 8.5 g/L) (P ＜ 0.05).There were no significant differences between the 2 groups in TAD,Cal-TAD,fracture healing time (3.7 ± 0.9 months versus 3.7 ± 1.0 months),or Harris hip score (73.4 ± 10.7 versus 75.5 ± 9.5) (P ＞ 0.05).Conclusion In the treatment of femoral intertrochanteric fractures with PFNA,lateral decubitus position may be associated with shorter operation time and less intraoperative blood loss compared with supine position.

Objectives To provide prenatal diagnosis and genetic counseling for four athigh-risk pregnant women with a suspected family or personal history of fragile X syndrome (FXS) by genetic screening of fragile X mental retardation (FMR1) gene.Methods This study was conducted on four pregnant women (No.l to 4) who received outpatient treatment in Peking University First Hospital from August 2014 to June 2016.Genomic DNA was extracted from peripheral blood samples of the pregnant women and six of their family members,four of which were suspected or confirmed FXS and the other two were FMR1 gene carriers.Amplide X kits were used to detect CGG repeat size in FMR1 gene.Two amniocytes and one chorionic villi samples were collected from three pregnant women to extract DNAs for FMR1 gene and karyotyping analyses.Results There were patients diagnosed with FXS in all the families by detecting CGG repeat numbers in FMR1 gene.The pregnant woman No.1 was a permutation carrier;No.2 carried normal FMR1 alleles while her brother had a mutation with over 20 CGG repeats in FMRI gene at chromosome X.No.3 and 4 were full mutation carriers with over 200 CGG repeats in FMR1 gene.After genetic counseling,No.3 decided to terminate the pregnancy due to abnormal fetal karyotype (47,XY,+21) and full mutation of FMR1 alleles.No.1 and 4 continued to pregnancy as their fetuses were normal in FMR1 alleles and karyotype.No.2 continued to pregnancy as her fetus was free of FXS risk.Conclusions Prenatal diagnosis and genetic counseling should be conducted on women at highrisk for FXS to avoid birth defects.People with a family history of FXS should be tested for FMR1 gene carrier status.

By using SWOT method, we analyze the strengthen, weakness, existing opportunity and challenging of applying Mini-CEX which is named Mini Clinical Evaluation Exercise in theOrgan-system-based curriculum modelclinical nursing teaching, and propose related development strategy of Mini-CEX.

Objective To explore the effect of preemptive anti-cytomegalovirus therapy on prognosis of patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) viraemia.Methods A non-random prospective study of male hospitalized patients were carried out who were newly diagnosed as AIDS during July 1,2011 to June 30,2013 in the First Affiliated Hospital of China Medical University.There were 69 patients who were divided into treatment group (57 cases) and control group (12cases).The duration of anti-cytomegalovirus therapy was a week after plasma CMV-DNA becoming undetectable.Baseline age,CMV-DNA,human immunodeficiency virus (HIV)-RNA,CD4+T cells,the rate of pneumocystis carinii pneumonia (PCP) and tuberculosis were evaluated between two groups.After 12-month follow-up,CD4 + T cells,the rate of rehospitalization,CMV retinitis,and mortality were evaluated.Results There were no difference in CMV-DNA,HIV-RNA,CD4 + T cells,the rate of PCP,and tuberculosis(P ＞ 0.05).At the end of 12 months,there were higher CD4 +T cells and lower rehospitalization rate in treatment group than control group(t =-3.850,P ＜ 0.05;x2 =6.078,P ＜ 0.05).CMV retinitis was not found.The mortality was not different between two groups(P ＞0.05).Conclusions Anticytomegalovirus therapy was beneficial to the increment of CD4 +T cells and decrement of rehospitalization,and prevention from CMV retinitis.

Objective To discuss the principle and the value of pereutanous microwave ablation for benign focal liver lesions. Methods Fourteen patients with 15 benign focal liver lesions received percutanous microwave ablation with 15G cool-tip microwave antenna. The maximum diameter of lesion was (26.2±13.6)mm (10 - 57 mm). Results Treatment sessions and total treatment time for single lesion were 1.4±0. 5 (1- 2) and (837±574)s (300- 2057 s). Follow-up range was 1- 35 months (median 6 months). The hepatic lesions were covered by coagulation necrosis region of ablation completely in all cases on contrast-enhanced at 1 month after ablation. The area of coagulation necrosis of ablation decreased on follow-up imaging in patients with more than 3 months follow-up. No complications happened in all cases. Side effects include pain (12/14) and fever (8/14) lasting I -9 days. The increase of serum transaminase decreased to normal at 1 week after ablation. Conclusions Percutanous microwave ablation has the merit of safety,minimal invasion, good ablation result and low incidence of side effect. Under the precondition of eareful choice of indication,pereutanous microwave ablation can be a selective treatment method for benign focal liver lesions.