AIM: To compare the effects of total intravenous anesthesia and balanced anesthesia on stress response on suspensive laryngoscope vocal cords surgery. METHODS: Thirty patients undergone microlaryngeal surgery were randomly divided into two groups(n=15). Analgesia and amnesia slow induction was used in all patiens with nosal incubation. During maintenance of anesthesia, propofol, remifentanil and scopolamine were used in total intravenous anesthesia group(group TIVA); fentanyl, scopolamine and isoflurane were used in balanced anesthesia group(group BAL). Record the data of each group,including base data, after induction, end of tracheal intubation,3 min after intubation, setting the suspensive laryngosopy, 3 min after setting the suspensive laryngosopy, removing the trachea, MAP, HR of each time, the time of recovery. The blood concentrations of epinephrine (E), noradrenalin(NE),cortisol,IL-6 were measured at each time point of base data, end of tracheal intubation, setting the suspensive laryngosopy, 3 min after setting the suspensive laryngosopy. RESULTS: There is no significant difference of HR, MAP, blood concentration of E,NE, cortisol, IL-6 at end of tracheal intubation compared with base data. AT setting the suspensive laryngosopy,3 min after setting the suspensive laryngosopy, HR, MAP, blood concentrations of E, NE, cortisol, IL-6 in group BAL were all higher than that of base data,and were also higher than group TIVA at the same time. The recovery time of group TIVA was shorter than that of group BAL. CONCLUSION: Analgesia and amnesia slow induction with nosal intubaion and maintenance with remifentanil, propofol can inhibit sudden change of hemodynamics and stress response of intubation and setting the suspensive laryngoscope, with quicker recovery .It is an ideal anesthesia method for suspensive laryngoscope vocal cords surgery.

Objective To explore the clinical effects of different regimens of letrozole in the treatment of PCOS in patients with infertility.Methods A total of 87 cases of PCOS infertility were selected as the research subjects.The patients were divided into the group A(44 cases of menstrual cycle 3rd~7th day oral letrozole 5mg/d), the group B 43 cases(3D of the menstrual cycle to take a one-time oral letrozole 20mg),ultrasound monitoring was used in the treatment process,when the maximum follicle diameter greater than or equal to 18mm,HCG intramuscular injection of human chorionic 10 000IU(HCG).The changes of endocrine hormones in the two groups were compared and the effect of ovulation induction was compared.Results Menstruation the fifth day serum T,FSH,LH,between the two groups had no statistically significant differences (P>0.05 ).The serum E2 in the group B [(106.1 ± 43.2)nmol/L]was lower than that in the group A[(183.2 ±69.4)nmol/L](t=6.204,P<0.05).Injection of HCG on the same day,the serum T,FSH and E2 between the group A and group B showed no significant differences(P>0.05),serum LH level in group B[(31.1 ±9.2)IU/L]was lower than that in the group A[(34.6 ±8.9)IU/L](t=2.010,P<0.05 ).In group B,the endometrial thickness,the number of mature follicles,the ovulation rate,the pregnancy rate within 12 months were (0.94 ±0.11)mm,(1.46 ±0.41),95.35%,35.26% respectively,which were significantly higher than those of the group A[(0.83 ±0.13)mm,(1.14 ±0.25),70.45%,13.64%](t=4.256,t=4.407,χ2 =9.445,4.398,all P<0.05).Conclusion The 3rd day at menstrual cycle,taking a single oral dose of letrozole 20mg program is favor of an early lowering E2 levels,and can promote follicular maturation and development,improve the pregnancy rate in patients with PCOS.

Objective:To investigate the effect of enhanced external counterpulsation(EECP)on heart failure with preserved ejection fraction(HFpEF)and hemodynamics in elderly patients.Methods:Clinical data of 66 elderly HFpEF patients admitted to the enhanced external counterpulsation center of our hospital from January 2018 to December 2019 were retrospectively analyzed.The primary assessment parameter was the six-minute walk distance, and the secondary parameters included the Minnesota Living with Heart Failure Questionnaire(MLHFQ). Noninvasive hemodynamic parameters including the cardiac index(CI), stroke volume(SV), isovolumic relaxation period(A2-mitral valve opening, A2-O), pulmonary capillary wedge pressure(PCWP)and total peripheral resistance(TPR)were monitored and mean arterial blood pressure(MAP)was calculated.Results:After EECP treatment, the six-minute walk distance increased(372±87 m vs.341±85 m, P<0.05), the score of MLHFQ decreased(47.0±16.0 vs.50.0±17.0, P<0.05), CI increased(2.8±0.7)L·min -1·m -2vs.(2.6±0.6)L·min -1·m -2( P<0.05), SV, PCWP and A2-O did not show significant change(73.3±16.4 ml vs.71.5±17.1 ml, 10.0±3.3 mmHg vs.11.0±3.6 mmHg, 1 mmHg=0.133 kPa, 98.0±29.5 ms vs.91.0±29.1 ms, P>0.05), TPR decreased(1 719.0±427.0 DS/cm 5vs.1 821.0±508.0 DS/cm 5, P<0.05), and there was no significant change in MAP(96.9±10.7 mmHg vs.98.8±13.1 mmHg, P>0.05), compared with pre-EECP treatment levels.Compared with patients without hypertension, MAP decreased in patients with hypertension(14 cases), when stratified by the initial MAP( P<0.05). Conclusions:For elderly patients with HFpEF, EECP can increase the six-minute walk distance, improve the quality of life and hemodynamic parameters, and is a safe adjuvant treatment.

and indexes of the ROI which had significant difference between the groups. Results In the white matter regions, MD, D∥and D⊥in many regions of AD group were increased significantly than the control group, and the differences were statistically significant. MD and D ⊥ showed more abnormalities, including the SCC, PCB, and FWM. Meanwhile, MK, K∥and K⊥in many regions of AD were decreased, and the differences were statistically significant. K ⊥ showed more abnormalities, including the SCC, FWM and TWM. In the gray matter regions, MD, D∥and D⊥of hippocampal of the AD group were all increased than the control group. However, it showed that MK and K⊥of the thalamus in AD group were 0.99 ± 0.10, 1.00 ± 0.11, respectively, and both increased than the control group (the value of MK and K⊥were 0.90±0.06, 0.90±0.07, respectively), and the differences were statistically significant (t values was 3.31, 3.57 respectively, and both P values were<0.01). The indexes of different ROI had correlations with the MMSE scores. There were more regions in kurtosis indexes correlated with the MMSE scores than the diffusion indexes. The strongest correlation among the analyses was MK of the SCC (r=0.73, P<0.05). Conclusions This study based on DKI found the complex alterations aroused by microstructural changes were not only in the white matter but also the gray matter of the AD patients, especially the increased kurtosis of the thalamus, and this suggested that the microstructural complexity of it was increased. Moreover, it also suggested that indexes of DKI had varied sensitivity in detecting different diffusion alterations.

Objective To explore the effect of body position training and specimen collection used in EBUS-TBNA.Methods A total of 102 patients with EBUS-TBNA in our hospital from June 2014 to August 2016 were selected as the study subjects.They were randomly divided into control group and experimental group, with 51 cases in each group, given routine nursing plan and improved nursing plan (body training), respectively.Nursing effect, improvement of mental state and the positive rate of specimen collection were observed.Results The nursing effect in the experimental group was significantly better than the control group, the differences were statistically significant (P<0.05);The SAS score, SDS score in experimental group were better than the control group (P<0.05);The pathological positive rate of the experimental group was 96.08%, which was significantly better than 84.31% of the control group, the difference was statistically significant (P<0.05).Conclusion Postural training and specimen collection used in the EBUS-TBNA can improve the accuracy of puncture and the positive rate o f pathological diagnosis, reduce pain of patients, and improve patients'' satisfaction, so it is worthy of clinical application.

Objective To explore the effect of body position training and specimen collection used in EBUS-TBNA.Methods A total of 102 patients with EBUS-TBNA in our hospital from June 2014 to August 2016 were selected as the study subjects.They were randomly divided into control group and experimental group, with 51 cases in each group, given routine nursing plan and improved nursing plan (body training), respectively.Nursing effect, improvement of mental state and the positive rate of specimen collection were observed.Results The nursing effect in the experimental group was significantly better than the control group, the differences were statistically significant (P<0.05);The SAS score, SDS score in experimental group were better than the control group (P<0.05);The pathological positive rate of the experimental group was 96.08%, which was significantly better than 84.31% of the control group, the difference was statistically significant (P<0.05).Conclusion Postural training and specimen collection used in the EBUS-TBNA can improve the accuracy of puncture and the positive rate o f pathological diagnosis, reduce pain of patients, and improve patients'' satisfaction, so it is worthy of clinical application.

OBJECTIVE:To provide reference for improving the level of pediatric drug supply and guarantee. METHODS:Questionnaire survey about the situation and causes of pediatric drug shortage was conducted in 13 third-level hospitals of Jiangsu province [directors of pharmacy department(or drug purchasers)and clinical pharmacists of each surveyed hospital]. The survey da-ta were analyzed statistically so as to provide suggestions. RESULTS:A total of 26 questionnaires were distributed,and 26 effec-tive questionnaires were collected with effective recovery rate of 100%. In 13 hospitals,special drugs for children were mostly less than 5% of hospital drug list. There were 82 kinds of special drugs for children(containing hospital preparation),mainly including Chinese patent medicine(35.37%),drugs for respiratory system(12.20%),vitamin,mineral substance and enteral and parenteral nutrient solution(10.98%). The most types of anti-infective drugs,antineoplastics,nervous system drugs and psychotropic drugs, digestive system drugs were in shortage among 126 pediatric drugs in shortage(8.73%). The reasons for pediatric drug shortage mainly included price(38.10%),production break(32.54%),failure to bid or no supply(13.49%). The shortage of cheap drugs with price of 0.01-10.00 was the most serious,accounting for 57.94% of the varieties in shortage supply. Respondents thought that special drug shortage most affected clinical treatment(38.46%),followed by poisoning rescue drugs(30.77%)and orphan drugs(15.38%). CONCLUSIONS:Special drugs for children account for a very small proportion in the hospital drugs list. Pediatric drug shortage is affected by many factors. Cheap drug shortage is the most serious. The shortage of special drugs for children and poison-ing rescue drugs is considered to have a great impact on clinical treatment. It is suggested to establish special drugs for children pro-tective policy,improve drug circulation,promote pediatric drug clinical trial and intensify the research and development of special drugs for children so as to guarantee pediatric drug supply.

Objective To investigate the effect and mechanism of bromodomain-containing protein 2(BRD2)on regulation of antitumor immunity,and to explore a novel target for immunotherapy.Methods The REMBRANDT glioma database and GlioVis and TIMER websites were used to compare the expression levels of BRD2 in tumor tissues and normal ones.The correlations between BRD2 expression levels and the prognosis of patients with glioblastoma multiforme(GBM)and those between BRD2 expression levels and immune cell infiltration in GBM were studied.The interference plasmid targeting the BRD2 gene was constructed.The lentivirus was packaged and used to infect murine glioma cells GL261.The positive cells were screened with blasticidin for 6 days,and the expression level of BRD2 protein was detected by Western blot.The CellTiter-Glo kit was used to detect the cell viability of GL261 cells after BRD2 knockdown,which were transplanted into the subcutaneous tissue of C57BL/6J mice to form subcutaneous tumors.The tumor volume was measured periodically.Twenty-eight days after tumor inoculation,the tumors were removed and tumor cells isolated.The infiltration of CD8+T cells within the subcutaneous tumor tissue was analyzed using flow cytometry and immunohistochemistry.Results BRD2 was highly expressed in a variety of tumor tissues.The prognosis of glioma patients with high BRD2 expressions was poor,and the BRD2 expression level was negatively correlated with CD8+T cell infiltration in the tumor.The growth rate of subcutaneously transplanted GL261 tumor cells after BRD2 knockdown was decelerated,and the infiltration level of CD8+T cells in subcutaneous tumor tissue was increased.Conclusion BRD2 over-expression inhibits the infiltration of CD8+T cells in GBM tumors and promotes the growth of tumors.

Objective To evaluate the clinical efficacy and safety of acupuncture in the treatment of grand anxiety disorder by applying Meta-analysis.Methods Randomized controlled trials on acupuncture treatment of generalized anxiety disorder in 7 Chinese and English databases from the establishment of the database to May 1,2022 were searched for screening,inclusion and literature risk assessment.Meta-analysis and subgroup analysis of different outcome indicators and/or intervention measures were performed using Stata 16 and Review Manager 5.4 software.Results Finally,20 randomized controlled trials were included,including 1661 cases and 4 intervention measures(acupuncture+electroacupuncture,acupuncture,electroacupuncture and western medicine).The results of meta-analysis indicated that there were statistically significant differences in HAMA and SAS scores between acupuncture group and western medicine group(P<0.05).The results of subgroup analysis showed that there was statistically significant difference in Hamilton anxiety scale(HAMA)score between acupuncture group and alprazolam.There was a statistically significant difference in self-rating anxiety scale(SAS)score between acupuncture group and simple paroxetine,buspirone,chlorhexidine/oryzanol/propranolol.In the evaluation of side effect scale,the difference between acupuncture(including electroacupuncture)group and western medicine group was statistically significant(P<0.01).Conclusion Acupuncture(including electroacupuncture)can effectively improve anxiety and symptoms with efficacy no less than that of Western medicine,and has the advantages of fewer adverse effects and higher safety.However,due to the quantity and quality of the included literature,multi-center,large sample,and high-quality randomized controlled studies are still needed to further corroborate the above conclusions.

Objective:To standardize the organization names of scientific research institutions in the field of Traditional Chinese Medicine (TCM), so as to effectively utilize the information of scientific research achievements.Methods:By establishing a thesaurus of the names of scientific research institutions in the field of TCM, this paper summarized the standardization rules of the names of TCM institutions and standardized the names of institutions by combining thesaurus and rules.Results:This paper built a thesaurus of 580 hospitals above level Ⅲ, 25 TCM colleges and universities and 17 TCM research institutes in China. Two manual spot checks were carried out on the standardized processing results of the organization names field in the title of the papers. The average accuracy, recall rate and F-Measure were 99.5%, 96.4% and 97.9% respectively.Conclusion:The method of combining institution thesaurus and rules is used to standardize the names of TCM institutions , which is with high accuracy and recall rate, and can provide reference for the standardization of the names of TCM institution.