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.

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 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.

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 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.

Objective:To explore the effects of SOAP (subjective objective assessment plan) case recording method by reflective teaching combined with the framework of International Classification of Functioning-Children and Youth Version (ICF-CY) in rehabilitation therapy practice.Methods:Interns of rehabilitation therapywere randomly divided into ICF-CY record group taking the case recording method of reflective teaching combined with the framework of ICF-CY and traditional record group taking traditional SOAP case recording method for children with cerebral palsy. After the internship, examination based on the clinical analysis and assessment of cases records and questionnaire survey were conducted among the two groups of interns. SPSS 20.0 was used to conduct t test and chi-square test. Results:The scores based on the clinical analysis and assessment of the ICF-CY record group were higher than those of the traditional record group. The questionnaire showed that interns' satisfaction of the SOAP case recording method by reflective teaching combined with the framework of ICF-CY was superior to the traditional SOAP case recording method ( P<0.001). Conclusion:The SOAP case recording method by reflective teaching combined with the framework of ICF-CY can improve interns' abilities of clinical case analysis, stimulate their self-learning abilities, and help to cultivate their thinking of clinical diagnosis and treatment.

Objective:This study aimed to evaluate the effect of enhanced external counterpulsation(EECP)on left ventricular function in elderly patients with coronary slow flow phenomenon(CSFP)using two-dimensional speckle tracking echocardiography(2D-STE).Methods:This prospective case-control study included 30 patients aged ≥60 years with no stenotic lesions in the coronary arteries but with slow blood flow phenomenon in more than one major coronary artery who were treated at the Department of Geriatrics, Qilu Hospital, Shandong University, between December 2017 and December 2018, and were divided into a medication group with 16 participants and a medication plus EECP group with 14 participants, using the numerical lottery method.Patients in the group treated with EECP received 6-week 36-h EECP therapy in addition to lifestyle modification and drug treatment.Fourteen patients with normal coronary blood flow served as the control group.Conventional echocardiography and 2D-STE were used to evaluate changes in left ventricular function in the CSF patients before and after drug treatment and EECP.Results:Compared with the control group before treatment, patients in the drug treatment group and the drug treatment plus EECP group showed a decrease in mitral annular early diastolic velocity( P<0.01), an increase in the ratio of peak mitral early diastolic blood flow velocity to the mean peak mitral annular early diastolic velocity( P<0.05), and a decrease in left ventricular longitudinal strain during systole( P<0.01), the longitudinal systolic myocardial strain rate( P<0.01)and the early diastolic longitudinal peak strain rate( P<0.01).There was no statistically significant difference in values from conventional echocardiographic parameters before and after treatment in CSF patients of the medication group(all P>0.05).In the group receiving EECP, there were statistically significant differences in pre-and post-treatment values in ventricular septal early diastolic velocity[(6.22 ± 0.64)cm/s vs.(6.69 ± 0.44)cm/s], lateral wall early diastolic velocity[(8.01±0.68)cm/s vs.(8.41±0.29)cm/s], mitral valve to mitral annulus early diastolic peak velocity ratio[(10.51±1.38) vs.(9.74±0.37)], longitudinal left ventricular systolic strain[(-16.21±0.46)% vs.(-16.80±0.48)%], left ventricular systolic longitudinal strain rate[(-1.29±0.03)s -1vs.(-1.35±0.04)s -1], and early diastolic longitudinal strain rate[(1.35±0.03)s -1vs.(1.40±0.03)s -1](t-values were -3.70、-2.74、2.23、10.25、12.30、-19.15, all P<0.05). Conclusions:2D-STE can evaluate subclinical myocardial dysfunction early and quantitatively in elderly patients with CSF, and objectively reflect changes in left ventricular function before and after clinical intervention with EECP.

Objective To investigate the comprehensive improvement of multi-system diseases in elderly patients treated with enhanced external counterpulsation(EECP).Methods Clinical data of an elderly patient with multiple systemic diseases were collected and analyzed.The therapeutic effect of EECP was assessed and EECP-related literatures were reviewed.Results The 62-year-old male patient was diagnosed with coronary atherosclerotic heart disease,unstable angina,New York Heart Association(NYHA)functional class Ⅱ,hypertension(grade 3,very high risk),type 2 diabetes,acute cerebral infarction (recovery period)and benign prostatic hyperplasia.After two courses of EECP treatment,angina in the patient was significantly relieved,cardiac systolic and diastolic function was improved,activity tolerance was increased and the corresponding dosage of therapeutic drugs was reduced.In addition,the patient's blood pressure and blood glucose levels were decreased after versus before treatment and the retinal superficial blood flow was enhanced in both eyes assessed by optical coherence tomography.The frequency and volume of nocturia were reduced.The symptoms of numbness on the left side were improved.Conclusions EECP treatment has shown significant therapeutic effects on multi-system diseases in the elderly patient.EECP is safe,effective and simple and has a broad application prospect in geriatrics.

Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2018 to December 2019. Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 14 778 bacterial strains were collected from 50 hospitals, of which 4 117 (27.9%) were Gram-positive bacteria and 10 661(72.1%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.2%), Klebsiella pneumoniae (17.0%), Staphylococcus aureus (9.7%), coagulase-negative Staphylococci (8.7%), Pseudomonas aeruginosa (3.7%), Enterococcus faecium (3.4%), Acinetobacter baumannii(3.4%), Enterobacter cloacae (2.9%), Streptococci(2.8%) and Enterococcus faecalis (2.3%). The the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus were 27.4% (394/1 438) and 70.4% (905/1 285), respectively. No glycopeptide-resistant Staphylococcus was detected. More than 95% of S. aureus were sensitive to amikacin, rifampicin and SMZco. The resistance rate of E. faecium to vancomycin was 0.4% (2/504), and no vancomycin-resistant E. faecalis was detected. The ESBLs-producing rates in no carbapenem-resistance E. coli, carbapenem sensitive K. pneumoniae and Proteus were 50.4% (2 731/5 415), 24.6% (493/2001) and 35.2% (31/88), respectively. The prevalence of carbapenem-resistance in E. coli and K. pneumoniae were 1.5% (85/5 500), 20.6% (518/2 519), respectively. 8.3% (27/325) of carbapenem-resistance K. pneumoniae was resistant to ceftazidime/avibactam combination. The resistance rates of A. baumannii to polymyxin and tigecycline were 2.8% (14/501) and 3.4% (17/501) respectively, and that of P. aeruginosa to carbapenem were 18.9% (103/546). Conclusions:The surveillance results from 2018 to 2019 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while E. coli was the most common pathogen, and ESBLs-producing strains were in majority; the MRSA incidence is getting lower in China; carbapenem-resistant E. coli keeps at a low level, while carbapenem-resistant K. pneumoniae is on the rise obviously.