Objective To discuss the application effect of lateral prone position in the left trigeminal nerve root microvascular decompression on the degree of compression on axillary nerve and arm discomfort,in order to supply evidence for selection of a suitable position during trigeminal nerve root microvascular decompression.Methods 44 cases who underwent microvascular decompression of trigeminal nerve roots were randomly divided into the observation group and the control group with 22 cases in each group.They were in lateral prone position with their arms placed in different positions.The influence on arm function was observed in two groups.Results The arm feeling,response to pain,the upper limb swelling and flexibility were statistically significant between two groups.Conclusions For lateral prone position arrangements during microvascular decompression of trigeminal nerve root,the patients' head should be moved ahead,the right arm should be out of bed and be fixed in a lower position,so that nerve and functional damage can be prevented by avoiding decompression of the right upper arm.

Objective To observe the clinical efficacy ofTong Yuan(short forTong Du Tiao Shen,Yin Qi Gui Yuan, referring to unblocking the Governor Vessel, regulating mind, and guiding qi back to the origin) needling method plus Letrozol and human chorionic gonadotropin (HCG) in treating refractory sterility caused by polycystic ovary syndrome (PCOS).Method Sixty clomiphene citrate-resistant PCOS-induced sterility patients were recruited and randomized into two groups. The treatment group was intervened byTong Yuanneedling plus Letrozol and HCG, while the control group was intervened only by Letrozol and HCG, both for 3 months. Prior to and after the treatment,the levels of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) were detected; the endometrium, ovulation and pregnancy rates were also observed.Result After 3 menstrual cycles, the level of FSH increasedsignificantly (P<0.05), LH decreased significantly (P<0.05), LH/FSH declined significantly (P<0.05), and the level of T also dropped significantly (P<0.05) in both treatment group and control group; the level of E2also dropped significantly after the treatment in both groups (P<0.05), and the decrease in the treatment group was more significantly than that in the control group (P<0.05). The ovulation and pregnancy rates in the treatment group were significantly higher than those in the control group (P<0.05).Conclusion Tong Yuanneedling plus Letrozol and HCG can significantly down-regulate the levels of LH, E2and T, up-regulate the level of FSH, effectively improve the internal reproductive environment of refractory PCOS patients, and enhance the ovulation and pregnancy rates.

BACKGROUND: Early clinical researches suggest that mediodespidine capsule can decrease blood pressure of patients with primary hypertension on the basis of yanggan qinggan pinggan technique.OBJECTIVE: To observe the effect of mediodespidine capsule on primary hypertension and angiotensin Ⅱ (Ang- Ⅱ ) of patients in the types of yin deficiency, yang excess and liver fire.DESIGN: Randomized controlled case observation.SETTING: Department of Cardiology, First Affiliated Hospital, Hunan University of Traditional Chinese Medicine.PARTICIPANTS: Patients were selected from the Inpatient Department and Out-patients Clinic of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine between April 1999 and April 2000. Inclusion criteria: Patients, who were diagnosed with the criteria of primary hypertension, who belonged to the types of yin deficiency, yang excess and liver fire, who could endure this test, who were coincidence with the criteria of mental-stress test, were all consent. Exclusion criteria: Patients who had severe congestive heart failure, atrophic arthritis and unable tolerance were excluded. There were 60 cases in total, including 29 males and 31females. All patients were divided into mediodespidine group and verapamil group with 30 in each group on the basis of randomly digital table.METHODS: Patients who had positive results of awaken mental-stress test were involved in this study. Cases in mediodespidine group were treated with mediodespidine capsule, which was made of tall gastrodia tuber, spine date seed and fourstamen stephania root at the dosage of 0.43 g/pill and were provided by the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine (wei yao ji zi: 05-047, batch number: 990503), five pills each for 3 times a day. Cases in verapamil group were treatedwith verapamil (40 mg/pill, Shanghai Huanghe Liya PharmaceuticalCompany Limited,batch number: 980301B) 80 mg each for 3 times a day. The course in both groups was 4 weeks. ① Effect of blood pressure: Average value of blood pressure tested for 3 successive days were regarded as the blood pressure before treatment, and average value of blood pressure tested for 3 times after treatment was regarded as the blood pressure after treatment. ② Effect of symptom:Scores were recorded as four levels according to main symptoms, such as vertigo, headache, pain and weakness of waist and knees, before and after treatment. ③ Values of Ang- Ⅱ were measured with radioimmunoassay before and after cold pressor test. Effect on Ang- Ⅱ was evaluated with effect of decompression, effect of clinical symptom and criteria of clinical effect.MAIN OUTCOME MEARUSES: Clinical symptoms, values of blood pressure, heart rate and Ang- Ⅱ before and after cold pressor test.RESULTS: A total of 60 patients with primary hypertension were involved into the final analysis.① Totally effective rate of clinical symptoms of patients in mediodespidine group was higher than that of patients in verapamil group, but the effect of decompression was not significant between the two groups (P ＞ 0.05). ② There was remarkably significant difference of heart rate in both groups before and after treatment (P ＜ 0.01), especially the decrease in verapamil group was great, and there was significant difference (P ＜ 0.05). ③ Values of systolic pressure and diastolic pressure were decreased in both groups after cold pressor test (P ＜ 0.01), but there was no significant difference between the two groups (P ＞ 0.05). ④ There was no significant difference in clinical effect between the twogroups (P ＞ 0.05).⑤ After treatment, concentration of Ang- Ⅱ at basic level in both groups was decreased, and there was significant difference between them (P ＜ 0.01);concentration of Aug-Ⅱ was decreased in both groups after cold pressor test as compared with that before treatment, but there was no significant difference between them (P ＞ 0.05).CONCLUSION: Mediodespidine capsule can decrease blood pressure stably, and the effect is stronger than that of verapamil at the aspect of decompression and improving symptoms. Blood pressure of patients with primary hypertension in the types of yin deficiency and yang excess or liver fire can be decreased by decreasing the level of plasma Ang-Ⅱ to a certain degree.

Objective To analyze the patterns of amino acid changes in liver failure patients treated with non-bioartificial liver support system (ALSS), and to explore the efficacy of ALSS in liver failure treatment. Methods A total of 146 liver failure patients treated with ALSS from June 2009 to August 2010 were recruited in this study. Paired blood samples were collected from every patient and serum amino acids and ammonia were tested by automatic amino acid analyzer. The changes of amino acids in patients with different prognoses, different types/phases of liver failure were evaluated.Measurement data were compared by paired t test. Results After ALSS treatment, liver failure patients experienced a significant decrease in serum glutamic acid and lysine [(395.62±200.24)μmol/Lvs (260. 05±169.56) μmol/L and (436. 73±326. 18)μmol/L vs (407. 12±292.01) μmol/L,respectively; t= 8. 611 and 2. 659, respectively; both P＜0.01)], while experienced greatly increases in threonine and branched-chain amino acids/aromatic amino acid ratio [( 1302. 90 ±1288.70) μmol/L vs (1406.70 ±1272. 34) μmol/L and 1. 23 ± 0. 53 vs 1. 36 ± 0.57, respectively; t = 2. 895 and 1. 061,respectively; both P＜0. 01)]. The changes of glutamic acid, tyrosine, arginine and methionine before and after ALSS treatment in patients with different prognoses, different types/phases of liver failure were all significantly different. Conclusions ALSS treatment could improve the serum amino acid disorder in liver failure patients. The amino acids in patients with different types/phases or different prognoses of liver failure change significantly after ALSS treatment.

Objective To determine the content of total flavonoids and luteolin from Pteris multifida Poir. Methods The content of total flavonoids was determined by gradient elution of macroporous resin D101 and ultraviolet spectrophotometry. The content of luteolin was determined by HPLC. The analysis was performed on a RP-C18 column(4.6 mm×250 mm, 5 μm) with aceconitrile-0.2% phosphoric acid (35:65) as the mobile phase at a flow rate of 1.0 ml/min, and 30 ℃ temperature. Results The detection of wave length was set at 349 nm. The content of luteolin was 0.015%, 0.019%, 0.016%, and the content of total flavonoids was 0.015%, 0.019%, 0.016%, respectively. Conclusions The method is suitable for the determination of flavonoids componets from Pteris multifida Poir.

Objective To evaluate the clinical efficacy of small endoscopic sphincterotomy combined large-bal-loon dilation in treatment of common bile duct stones 1.0~2.5 cm in diameter. Methods 426 patients with large common bile duct (CBD) stones 1.0~2.5 cm in size were reviewed in our hospital between June 2010 and June 2014. They were randomized underwent small endoscopic sphincterotomy combined large-balloon dilation (SESPLBD) (n=218) or endoscopic sphincterotomy (EST) ( n= 208) for lithotripsy. The therapeutic outcome and complications were reviewed and compared. Results SESPLBD had higher complete duct clearance in one session (95.41 % vs. 93.75%), but there was no statistical significant difference. Bleeding was much less occurred in SESPLBD than in EST (2.29 % vs. 7.69 %, P= 0.025), especially when the stones were bigger than 1.5 cm in diameter. Mechanical lithotripsy was performed less in SESPLBD (13.76%vs 25.96 %, P=0.002), especially when the stones were 1.5 ~2.0 cm in diameter. There was no statistical significant difference in the incidence rate of post-ERCP pancreatitis (9.17 % vs. 6.73 %,P = 0.452), hyperamylasemia (19.72 % vs. 18.27 %,P = 0.796), perforation and death. Conclusions SESPLBD could be a safe method for large bile duct stones 1.0~2.5 cm in size. Compared with routine EST, it had less bleeding rate and mechanical lithotripsy requirement without increasing the incidence rate of post-ERCP pancreatitis or hyperamylasemia.

Objective To explore the relationships among nurses’intent to stay,occupational commitment and managers’ leadership styles in emergency department.Methods A total of 130 nurses in emergency department were recruited by convenience sampling method from three tertiary hospitals in Guangzhou.They were investigated by using Nurses’Intent to Stay Questionnaire, Nurses’Occupational Commitment Questionnaire and Multifactor Leadership Questionnaire(MLQ).Results The score of nurses’ intent to stay and occupational commitment were(20?19±3?74)and(76?16±12?13),respectively;both were at medium levels and occupational commitment,transformational leadership style were positively correlated with nurses’intent to stay(P<0?05).Nurses perceived their managers as transformational leaders more often than transactional leaders.Conclusions Both the current nurses’ intent to stay,occupational commitment were at medium levels.The influential factors of nurses’intent to stay in emergency department included emergency work experience,emotional commitment and normative commitment.In order to increase nurses’retention and stabilize the healthy development of nursing personnel,nurse managers should improve the level of nurses’occupational commitment.

In order to express the gene of LEN-5 β-lactamase from a Klebsiella pneumoniae strain,plasmids in the strain were extracted and an 879bp product of LEN-5 gene was obtained with PCR.After being digested with Nde I and Xho I,LEN-5 gene was cloned into pET-26b (+) vector.Then it was confirmed by digestion and DNA sequencing in recombinant plasmid before transformed into E.coli BL21 (DE3).After inducing by IPTG,LEN-5 β-lactamase was expressed.Protein extraction was processed by ultrasonic and protein activity was detected by nitrocefin.The isoelectric focusing electrophoresis showed a pI of 7.6.These results indicated that the LEN-5 gene has been cloned and expressed in prokaryote cell successfully.

Objective To investigate the antimicrobial resistance mechanisms and genetic homogeny of Salmonella from community acquired infections in Shenzhen,China.Methods Ninety-three of Salmonella were isolated from 2002 to 2007 at Shenzhen People's Hospital,China.PCR and DNA sequencing were used to investigate the mutation in QRDR of the gyrA,gyrB,parC and parE.Plasmid mediated quinolone resistance genes including qnr and aac(6')-Ib-cr,β-lactamase genes including blaTEM,blaSHV,blaOXA, blaCTX-M, and class 1 integron were detected. All isolates were typed by PFGE. Results S. enterica typhi and S. enterica paratyphi A were susceptible to ampicillin, chloramphenicol, trimethoprim/sulfamethoxazole, ceftriaxone and ciprofloxacin, with the susceptible rate of 96%-100%. Fifty-two percent (13/25) of S. enterica typhi and 95% (61/64) of S. enterica paratyphi A were resistant to nalidixic acid. Twenty-four percent (6/25) of nalidixic acid-resistant S. enterica typhi and 94% (60/64) of nalidixic acid-resistant S. enterica paratyphi A showed decreased susceptibility to ciprofloxacin (MIC of 0. 125-1 μg/ml).All nalidixic acid-resistant (susceptible to ciprofloxacin ) Salmonella (NARS) isolates had a single substitution in the QRDR of GyrA, and 91% (68/75) of these isolates carried the substitution Ser83Phe in GyrA. Two mutations in the QRDR of GyrA were detected in both of two ciprnfloxacin-resistant Salmonella,with the additional one mutation in the QRDR of parC. Plasmid mediated quinolone resistance genes including qnr and aac(6')-lb-cr were not detected in any isolate. The blaCTX-M-14 gene was detected in a ceftriaxoneresistant isolate of S. enterica paratyphi A, with ISEcpl located on the upstream of it. Three muhidrugresistant strains of Salmonella all carried one 1 900 bp classⅠ integron gene cassette dhfrⅫ-orfF-aadA2,with the additional one β-lactamase gene of blaTEM-1, or blaOXA-30. Twenty-two distinct PFGE patterns were observed among twenty-five S. enterica typhi. The PFGE patterns of sixty-four S. enterica paratyphi A showed limited genetic diversity (average similarity of 91% ). Ninety investigated inpatients were infected in the community. Six patients infected by S. enterica paratyphi A had a travel history before infection. Conclusions Nalidixic acid-resistant S. enterica typhi and S. enterica paratyphi A are highly prevalent in Shenzhen,China. The mutation in the QRDR of GyrA is the prevalent mechanism responsible for the resistance to nalidixic acid in Slmonella. The great genetic similarity among S. enterica paratyphi A isolates indicates endemic disease from the presence of a single clone over 6-year period.

Objective To study interdialytic body weight gain(IBWG)in maintenance hemodialysis(MHD)patients,and to analyze the associated factors. Methods A total of 269 patients undergoing maintenance hemodialysis were enrolled in this cross-sectional study.The patients were divided into two groups according to the percentage of IBWG(PIBWG:interdialytic body weight gain/dry weight×100%):PIBWG＞3.50%(190 cases)and PIBWG≤3.50%(79 cases).Associated factors of IBWG were analyzed. Results The average IBWG of 269 MHD patients was(2.42±1.01)kg(0-6.33 kg),and PIBWG was(4.25±1.79)%.In male patients,IBWG was (2.45±1.09)kg,and PIBWG was(3.99±1.79)%.In female patients,IBWG was(2.39±0.85)kg,and PIBWG was(4.64±1.74)%which was significantly higher compared to males(P＜0.01).Patients with PIBWG＜3.00%accounted for 20%,with PIBWG≥3.00%to＜5.00%accounted for 50%,with PIBWG≥5.00%accounted for 30%.Compared to patients with PIBWG＞3.50%,those with PIBWG≤3.50%were characterized by elder age(year)(60.50 ±14.49 vs 54.07±13.78),more males(70.88%vs 54.74%),shorter dialysis duration(month)(41.03±41.92 vs 58.83±43.57),larger BMI(kg/m2)(22.67±3.36 vs 20.91±3.25)and less dry weight(kg)(56.69±10.94 vs 62.82±10.97),more residual urine(ml,In)(6.19±0.94 vs 5.48±0.8),lower predialysis serum β2MG(mmol/L)(31.61±9.82 vs 38.54±10.38)and phosphorus(mmol/L)(1.92±0.66 vs 2.15±0.58).Correlation analysis revealed that PIBWG was positively correlated with dialysis duration,Scr,BUN,β2-MG,phosphorus,decrease and decrease percentage of BP during hemodialysis,and negatively correlated with age,dry weight,BMI,residual urine,and pre-dialysis SBP,MAP. Conclusions PIBWG of about 70%of our patients was below 5%.Young.female.low BMI and dry body weight,long dialysis duration,low residual urine,chronic glomerulonephritis and diabetic nephropathy are associated with more IBWG,which may lead to greater intradialytic BP fluctuation.