ObjectiveTo investigate the feasibility and clinical effect of bispectral index (BIS) monitoring target controlled infusion of midazolam and propofol for sedation of mechanically ventilated patients.MethodsEighty cases with severe respiratory failure,sane,the need for endotracheal intubation mechanical ventilation for at least 24 h were divided into 4 groups by random digits table with 20 cases each.Group A and group C patients routinely received propofol and midazolam,group B and group D patients used BIS monitoring target controlled infusion of propofol and midazolam.The correlation of BIS and Ramsay score was analyzed,and the changes of mean arterial pressure (MAP) and heart rate (HR) were compared among 4 groups.ResultsBIS was negatively correlated with Ramsay score in group B and group D (P ＜ 0.05).MAP after 24 h intubation was lower than that at intubation immediately among 4 groups [group A:(63.89 ±4.68) mm Hg (1 mm Hg =0.133 kPa) vs.(92.33 ±3.57) mm Hg,group B:(62.66 ±3.97) mm Hg vs.(93.76 ± 4.02) mm Hg,group C:(64.59 ± 3.29) mm Hg vs. (93.78 ± 4.61 ) mm Hg,group D:(63.18 ±2.51 )mm Hg vs. (93.61 ± 5.36) mm Hg],and there were significant differences (P＜ 0.05).Group A and group B reached the standard after 1 h intubation.HR after 24 h intubation decreased in 4 groups,but there was no significant difference (P ＞ 0.05).ConclusionsBIS monitoring target conmolled infusion of midazolam and propofol for sedation of mechanically ventilated patients can achieve similar sedative effects,in addition,the need for rapid sedation of mechanically ventilated patients with suitable choice of propofol.At the same time,BIS is negatively correlated with Ramsay score.

The objective of this study is to compare the normalized prediction distribution errors (NPDE) and the visual predictive check (VPC) on model evaluation under different study designs. In this study, simulation method was utilized to investigate the capability of NPDE and VPC to evaluate the models. Data from the false models were generated by biased parameter typical value or inaccurate parameter inter-individual variability after single or multiple doses with the same sampling time or multiple doses with varied sampling time, respectively. The results showed that there was no clear statistic test for VPC and it was difficult to make sense of VPC under the multiple doses with varied sampling time. However, there were corresponding statistic tests for NPDE and the factor of study design did not affect NPDE significantly. It suggested that the clinical data and model which VPC was not fit for could be evaluated by NPDE.

Objective To evaluate the changes in plasma S-100β protein concentration in patients undergoing cardiac surgery performed with cardiopulmonary bypass (CPB).Methods ASA Ⅱ or Ⅲ patients aged 60-77 yr weighing 55-75 kg with national institutes of health stroke scale(NIHSS) ＜ 10 undergoing coronary artery bypass grafting with CPB were enrolled in this study.Cerebral function was evaluated and scored using NIHSS at 2 d after operation.The patients were divided into 3 groups according to NIHSS scores:group A uncomplicated (NIHSS score 0-9),group B mild brain injury (NIHSS score 10-19) and group C moderate and severe brain injury (NIHSS 20-45).Plasma S-100β protein concentration was measured before CPB,at 30 min of CPB,the end of CPB and 1 h,6 h,24 h after CPB.The duration of operation,CPB time,aortic cross-clamping time and length of ICU stay and hospital stay were recorded.Results Ten patients in groups A and B and 12 in group C completed the trial.Plasma S-100β protein concentration was significantly increased during and after CPB as compared with the baseline at T0 and peaked at T3 (groups A,B) and T4 (group C).The plasma S-100β protein concentration was highest in group C and lowest in group A.The duration of operation,CPB time,aortic cross-clamping time and length of ICU stay and hospital stay were longest in group C and shortest in group A.Conclusion Plasma S-100β protein concentration can be used as a marker of cerebral injury after cardiac surgery performed with CPB and the concentration measured at 6 h after CPB is more significant in evaluating the degree of cerebral injury and prognosis.

Objective To investigate the accuracy of myeline base protein (MBP) in evaluation of brain injury in patients undergoing cardiac surgery performed under CPB. Methods Thirty-two ASA Ⅱ- Ⅳ patients of both sexes (20 males, 12 females) aged 59-76 yr weighing 52-72 kg undergoing coronary artery bypass grafting (CABG) under CPB were studied. Patients with history of neurological disease were excluded. Preoperative National Institute of Health stroke scale (NIHSS) score ≤ 9. According to postoperative NIHSS score on 2nd postoperative day, the patients were divided into 3 groups: group A no neurological deficit ( NIHSS score 0-9 );group B mild neurological deficit (NIHSS score 10-19) and group C moderate or severe neurological deficit (NIHSS score 20-45). Blood samples were taken from internal jugular vein before CPB (T0), at 30 min of CPB (T1), at the discontinuation of CPB (T2), and at 1, 6, 24 h after discontinuation of CPB (T3-5) for determination of the plasma MBP concentration. The duration of operation, CPB time, aortic cross-clamping time were recorded.Results In group B the plasma MBP level peaked at 6 h after CPB (T4) and then decreased rapidly while in group C the plasma MBP level exceeded the normal upper limit at T2 and kept increasing till 24 h after CPB (T5 ).The plasma MBP level decreased at T1-3.5 in group A as compared with the normal upper limit. The plasma MBPlevel was significantly higher at T3-5 in group B and at T1-5 in group C than in group A and at T1-5 in group C than in group B. Linear regression analysis indicated that there was positive correlation between plasma MBP level and CPB time at T5. NIHSS scores were positively correlated with plasma MBP level at T1 , T2, and T5. Conclusion MBP can early reflect the severity of brain injury in patients undergoing cardiac surgery under CPB.

Objective:From a professional competency-based perspective,this study aimed to explore appro-priate ways for certifying counselors and psychotherapists in China,and focused on improving the evaluation pro-gram for clinical and counseling psychologist of the Clinical and Counseling Psychology Registration System (CCPRS)of Chinese Psychological Society.Method:The theories and methods for certifying counselors and psy-chotherapists in China and overseas were summarized by using the literature method,based on which the design principles for certification in China were determined.Using the expert method,the core competencies of Chinese counselor and psychotherapist were proposed to form the index system of evaluation.A survey was also conducted to obtain a preliminary validity of the improved evaluation program.Result:Design principles for certifying coun-selors and psychotherapists were multi-trait,multi-method,and multi-informant.The core competencies of Chinese counselor and therapist included six domains,which were professional attitudes and conduct,ethics and law,clinical knowledge and skills,science and research,relationship building,cultural diversity and Chinese culture,case man-agement,respectively.Results from the expert judgments indicated that the evaluation materials which formulated by the improved program could assess all six core competencies and had acceptable reliabilities(Cronbach's α=0.74-0.97).And the expert evaluation about the improved program was high.Conclusion:The core competencies of Chinese counselor and therapist,which formulated by the improved evaluation program,reflect the necessary attitudes,knowledge and skills that needed when engaged in the professional practice of counseling and psychothera-py,and also can be used as a reference for counselor and psychotherapist education,training,practice,and compe-tency evaluation in China.The improved evaluation program can be used as a transitional way for certifying coun-selors and psychotherapists in China.

To investigate the prevalence of mental health problems in male violent offenders of Hunan and Sichuan Provinces; and to compare the types and severity of problems between the violent and nonviolent offenders.Methods:Ninety-one violent juvenile offenders and 64 nonviolent juvenile offenders in the juvenile detention centers of Hunan,and 81 violent juvenile offenders in the juvenile detention centers of Sichuan; 39 high school students from a middle school of Hunan Province and 49 from a middle school of Sichuan Province were investigated using the Investigation Screening Inventory for Child Mental Disorder and the Kiddy Schedule for Affective Diseases and Schizophrenia (K-SADS-PL),and classified according to the Diagnostic and Statistical Manual of Mental Disorders.Results:In the Hunan violent group,86.6％ met the criterion of conduct disorder (CD),17.6％ of substance abuse,9.9％ of substance dependence,while in the Hunan nonviolent group,75.0％ met the criterion of CD,and 11.7％ of substance abuse; these were all significantly higher than those of the control group (P＜0.05).In the Sichuan violent group,17.3％ met the criterion of attention deficit/hyperactivity disorder (ADHD),18.5％ of oppositional defiant disorder (ODD),69.1％of CD,and 22.2％ of substance abuse; these were all significantly higher than those of the Sichuan control group.Moreover,63.7％ of Hunan-violent,55.6％ of Sichuan-violent,and 45.0％ of Hunannonviolent offenders had a previous offence records.Conclusion:Mental and behavioral disorders among delinquent youth is becoming a serious problem,and there is an urgent need to develop and implement effective assessment and treatment approaches for juvenile offenders with the aim of reducing offence and recidivism in this population.

BACKGROUND:Percutaneous hol ow screw under X-Ray fluoroscopy has been shown to treat fracture of acetabulum of the pelvis, but the time of internal fixation was long, and the amount of radiation exposure to the patients and physicians was large.
OBJECTIVE:To test the application of the ISO-C3D METHODS:Thirty-one patients with fracture of the acetabulum were treated with percutaneous hol ow screw under a fluoroscopy-based ISO-C computerized navigational system for fracture of acetabulum. 3D computerized navigational system. The interval from injury to operation was 4 to 13 days. Al patients were fol owed up for one year.
RESULTS AND CONCLUSION:The average bleeding volume during operation was only 18 mL, except that the bleeding volume of only one patient, who suffered from the sacroiliacjoint injury and received open reduction and internal fixation, was up to 300 mL. The total number of screws used in the operation was 42, among which 24 were screws for acetabular anterior column fracture and 18 for posterior column fracture. Al screws were implanted once precisely. The average time of internal fixation was 59 minutes, and the mean time for fluoroscopy was 39 seconds. The 31 patients were pain-free one week after the operation and no complication (infection, vascular nerve injury or implant breakage) was noted post-operatively. When the fol ow-up ended, radiography revealed fracture union with satisfactory screw fixation (no screw breakage or loosening). According to Matta functional scoring, results were excellent in 23 cases, good in 8 cases, with an excellent and good rate of 100%. According to Majeed functional scoring, the results were excellent in 22 cases, good in 6 cases and average in 3 cases, with an excellent and good rate of 90%. These results indicated that ISO-C3D computerized navigational system can supply stable internal fixation without an increase of complication.

Objective To investigate the effectiveness of Varenicline combined with MEDCHART application software for health education and follow-up in patients at smoking cessation clinic.Methods A total of 104 cases who had smoking cessation counseling and intervention at smoking cessation clinic from February 2014 to January 2015 were divided randomly into MEDCHART APP group (n=51) and conventional group (n=53).Both groups were intervened by brief admonishment and given Varenicline.The 9-12 weeks and 26th week protracted continuous abstinence rates were observed.Results There were no significant difference in 9-12 week protracted withdrawal rate between 26th week APP and conventional groups (56.9％ vs.45.3％),the 26th week abstinence rates in group MEDCHART APP (41.2％) were significantly higher than the conventional group (20.8％)(x2=5.088,P＜0.05).There was significant difference in full course completion rates between the two groups;15 cases (29.4％) completed the course in group MEDCHART APP,whereas 5 cases (9.4％) did so in conventional group (x2=4.405,P＜0.05).Conclusion MEDCHART APP can strengthen health education and follow-up,which helps extend the time for Varenicline,increase 26th week smoking cessation withdrawal rate.It is a useful tool for smoking cessation education and follow-up.

Objective To explore the correlation between acute gastrointestinal side effects caused by radiotherapy in pancreatic cancer and degree of gastroduodenal radioactive injury under gastoendoscopy.Methods From February 2010 to May 2015,112 patients with pancreatic cancer and received radiotherapy were enrolled.The correlation between gastroscopic findings and degree of gastrointestinal side effects (grade zero to five) was analyzed.The effects of different radiotherapy on the formation of radiation ulcers were also investigated.Chi-square test and Spearman correlation analysis were performed for statistically analysis.Results The incidence of radioactive gastroduodenitis was 57.1 ％ (64/112).The incidence of radiation-induced ulcer was 42.0 ％ (47/112).Among the 112 patients with pancreatic cancer and received radiotherapy,patients with over grade two nausea,vomiting,dyspepsia and constipation received symptomatic treatment.Thirty-one patients (27.7 ％) of them received appetitestimulating treatment,53 patients (47.3％) were given anti-nausea treatment,39 patients (34.8％)received therapy of promoting digestion,and 24 patients (21.4 ％) received therapy of relieving constipation.The incidence of radiation-induced ulcer in patients with grade one acute gastrointestinal side effects was 25.8 ％ (8/31),lower than that of patients with over grade two acute gastrointestinal side effects (48.1％,39/81),and the difference was statistically significant (x2 =4.595,P=0.032).The grade of acute gastrointestinal side effects was positively correlated with that of radiation-induced injury under gastroendoscopy (r=0.295,P =0.002).The incidences of radiation-induced ulcer of gamma knife radiotherapy and helical tomotherapy were 50.0 ％ (15/30) and 39.2 ％ (31/79),respectively,and the difference was not statistically significant (x2 =1.032,P =0.301).Conclusions The occurrence of radiation ulcers should be alerted if over grade two acute gastrointestinal side effects presented in patients with pancreatic cancer and received radiotherapy.The radiotherapy caused gastrointestinal side effects can not be evaluated just according to clinical symptoms.Endoscopic findings and pathological diagnosis are the gold standard.

OBJECTIVE To screen the anti-meticillin-resistant Staphylococcus aureus(MRSA)traditional Chinese materia medica(TCMM)by biosensor technique,targeted on the soluble penicillin binding protein 2a(PBP2a)of clinical MRSA.METHODS The soluble PBP2a with amino acid sequence from 25 to 668 from clinical MRSA were expressed in Escherichia coli by gene recombination technique.Then,the expressed product was identified and its biological function was analyzed.After the PBP2a was immobilized into the carboxymethyl dextran cuvette(CMD),the anti-MRSA TCMM was screened by means of biosensor.RESULTS The soluble protein PBP2a had been successfully expressed,whose relative molecular mass was 74?103.It was confirmed that the soluble PBP2a had transpeptidase activitiy and ?-lactamase activitiy.Subsequently,10 kinds of anti-MRSA TCMM were screened out by biosensor technique.Moreover,Radix Scutellariae,Rhizoma Coptidis and Spica Prunellae had greater anti-MRSA effect than others.CONCLUSIONS Anti-MRSA TCMM has been successfully screened out by biosensor technique,targeted on the soluble PBP2a of clinical MRSA.