Objective To analyze the dose‐effects of different doses of dexmedetomidine for sedation and sleep of the patients under epidural nerve block anesthesia .Methods A total of 82 patients undergoing elective lower limbs surgery(ASA grade Ⅰ - Ⅱ) were randomly divided into 4 different doses of dexmedetomidine groups(group 1 ,n=19 ;group 2 ,n=22 ;group 3 ,n=20;group 4 , n=21) ,under continuous epidural nerve block ,the loading dose of dexmedetomidine 0 .7 ,0 .8 ,0 .9 ,1 .0μg · kg -1 · h-1 was intrave‐nously pumped for 30 min ,then pumped at a rate of 0 .7 ,0 .8 ,0 .9 ,1 .0 μg · kg -1 · h-1 in the group 1 ,2 ,3 and 4 respectively .If any patient in 4 groups fell asleep at less than half an hour ,the loading dose was stopped and the continuous dose was changed to pump , the drug administration was discontinued at wound dressing after operation .Whether the patient falling asleep was recorded ,and the mean arterial blood pressure ,heart rate at 4 time points of 10 ,30 ,60 ,90 min after infusion of dexmedetomidine were also recorded . The 50% effective dose(ED50 ) ,ED95 and 95% confidence interval(CI) were calculated by using the Probit method .Results ED50 and ED95 of dexmedetomidine were 0 .65μg/kg(95% CI:0 .36-0 .73μg/kg)and 1 .00 μg /kg(95% CI:0 .90-1 .74μg/kg) ,which could decrease the heart rate and increase the arterial blood pressure .Conclusion Although dexmedetomidine can decrease the heart rate and increase the arterial blood pressure ,but the patients quietly fall asleep without discomfort and pain occurrence by the intra‐venous administration under continuous epidural nerve block .

Accessory navicular source flatfoot is one of the foot deformity of clinical common disease,its treatment method is more controversial, differences in clinical efficacy of different surgical methods, according to accessory navicular source flatfoot symptoms of surgical treatment,there is no uniform standard, around a pair of accessory navicular excision how to reconstruct the arch produced a series of operation methods, the clinical curative effect of different operative methods produce also different, how to develop the operation strategy, choose operation method, and after acessory navicular excision whether to rebuild posterior tibial tendon, how to rebuild, the problems such as how to rebuild is the research hotspot and difficulty, looking forward to further research.
Flatfoot ; diagnosis ; surgery ; Foot Diseases ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Tarsal Bones ; abnormalities ; surgery

Objective To compare the curative effect of internal fixation treatment between reconstruction-type intramedullary nailing and long anatomic proximal femoral locking plate for patients with ipsilateral femoral proximal and shaft fractures. Methods Twenty-six patients with ipsilateral femoral proximal and shaft fractures were selected, among whom 12 patients were treated with reconstruction-type intramedullary nailing internal fixation treatment (group A), and 14 patients were treated with long anatomic proximal femoral locking plate internal fixation treatment (group B). The fracture to operation time, operation time, intraoperative blood loss, fracture healing time and hip joint function according to Majeed function score were compared between 2 groups. Results The fracture to operation time, operation time, intraoperative blood loss, proximal femoral fracture healing time, femoral shaft fracture healing time and Majeed function score in group A were (6.65 ± 4.11) d, (131.08 ± 20.70) min, (470.83 ± 96.43) ml, (17.83 ± 2.70) weeks, (20.08 ± 3.97) weeks and (83.83 ± 8.13) scores, and those in group B were (7.13 ± 4.56) d, (141.86 ± 27.30) min, (553.57 ± 127.80) ml, (18.29 ± 5.12) weeks, (21.55 ± 4.19) weeks and (83.21 ± 9.58) scores, and there were no statistical differences (P>0.05). According to Majeed function score, in group A excellent was in 7 cases, good in 4 cases, and general in 1 case; in group B excellent was in 9 cases, good in 3 cases, and general in 2 cases. Conclusions A fixation device fixes two fracture is preferred. Both treatment methods used in the present study could achieve satisfactory curative effect, and should be chosen according to the fracture type of the patients and the surgeon′s familiarity for the methods of internal fixation chosen. The proximal femoral fracture should preferably be reduced and stabilized first. A delay of 5 - 6 d would not affect the ultimate curative effect.

Objective: To understand the behavioral characteristics of vaccination of human papillomavirus (HPV) vaccine based on diffusion of innovation theory, and to put forward suggestions for improving the vaccination willingness. Methods: The women who had made an appointment or received at least one dose of HPV vaccine in two community health service centers with HPV vaccination qualification in Hangzhou were recruited by convenience sampling method. A questionnaire survey was conducted according to cervical cancer risk factors, HPV vaccine knowledge and the time of vaccination. The diffusion of HPV vaccination and the characteristics of vaccinees in different stages was analyzed. Results: A total of 448 women, aged from 18 to 45 years old, with a median of 30.5 years old, were investigated. The spread of HPV vaccine were divided into five stages: April 2017 and before was the initial stage, with 8 leaders, accounting for 1.79%; October 2017 to February 2018 was the slowly rising stage, with 59 early vaccinees, accounting for 13.17%; April 2018 to April 2019 was the rising stage, with 160 most early vaccinees, accounting for 35.71%; May to August 2019 was the rapidly rising stage, with 170 most late vaccinees, accounting for 37.95%; September 2019 to the end of the survey was the standstill stage, with 51 laggards, accounting for 11.38%. All of the leaders had participated in cervical cancer screening, voluntarily vaccinated, and knew the susceptible population of cervical cancer, the targeted HPV types and the suitable population of vaccine. The median age of the first pregnancy was 27 years old. Six of them had three pregnancies. The early vaccinees and the most early vaccinees were recommended by doctors or friends to get HPV vaccine. The median age of first pregnancy was 26 and 28 years old, respectively. Their other characteristics were similar to those of the leaders. The characteristics of most late vaccinees were similar to those of the laggards. They were were mainly students who were recommended by their friends to receive HPV vaccination, did not participate in cervical cancer screening, did not know the susceptible population of cervical cancer, the targeted HPV types and the suitable population of vaccine. Conclusions People with high risk of HPV exposure, awareness of cervical cancer and screening are more likely to receive HPV vaccination at the early stage. It is necessary to strengthen the health education of HPV vaccination, and make full use of the influence of doctors and early vaccinees, which is helpful to promote the early vaccination of HPV vaccine among the right age population.

Objective To evaluate the usefulness of 18F-FLT PET/CT imaging in detecting and staging nasopharyngeal carcinoma (NPC) patients.Methods Thirteen patients with NPC underwent wholebody 18F-FLT PET/CT imaging,one of which underwent whole-body 18F-FDG PET/CT imaging one day earlier.SUVmax and SUVmean from 18F-FLT and18F-FDG imaging were obtained using circular ROI in primary and metastasis lesions and were compared with the results of histopathology.The staging results by 18 F-FLT PET was compared with those by CT.Results The SUVmax and SUVmean obtained from 18F-FLT imaging in 22nasopharyngeal sites in 13 patients were 6.04 ±3.61 and 5.09 ±2.89,and the SUVmax and SUVmean in 26 lymphadenopathy were 5.56 ± 3.11 and 4.65 ± 2.79.18 F-FDG SUVmax were higher than 18 F-FLT SUVmax in one primary lesion ( 8.32 vs 4.38 ) and two lymph nodes (3.30 ± 0.07 vs 1.48 ± 0.06) in the patient who underwent the two imagings.Compared with CT staging results,the TNM stage in 3 patients had been changed based on 18 F-FLT PET/CT imaging.Conclusions High radioactivity of primary and second lesions can be detected on 18F-FLT imaging in patients with NPC and 18F-FLT PET/CT imaging may be useful in staging for NPC.

OBJECTIVE: To observe the chemical groups changing in rat kidney with regard to fatal hyperthermia by Fourier transform infrared microspectroscopy (FTIR-MSP) and to provide a new method to diagnose fatal hyperthermia. METHODS: Rats were sacrificed by hyperthermia, brainstem injury, massive hemorrhage and asphyxiation and divided into groups. The renal samples were dissected immediately after death. The data of infrared spectroscopy in glomerulus were measured by FTIR-MSP. RESULTS: The absorbances of 3290, 3070, 2850, 1540 and 1396 cm(-1) significantly increased (P < 0.05), and the ratios of Al650/A3290 and A1650/A1540 significantly decreased (P < 0.05) in group of hyperthermia. CONCLUSION FTIR-MSP can analyze the changes of chemical groups of kidney as an auxiliary diagnosis for discriminating hyperthermia with other causes of death.
Animals ; Fever/mortality* ; Fourier Analysis ; Kidney/metabolism* ; Microspectrophotometry ; Rats ; Spectroscopy, Fourier Transform Infrared/methods*

Brainstem of rats were stabbed with a needle and pathological changes of neurons and axons in brainstem were observed at different time after injury with Nissl's body staining, silver staining and modified trichrome staining. It was found that, by silver staining, the axons showed irregular swelling and disconnection at 1-3 h, marked swelling of the severe end at 6 h, retraction ball at 15 h and remarkable retraction ball at 24 h. By modified trichrome staining, the space between myelin sheaths and axons was widened at 3-6 h, and tortuous myelin sheaths adhered incompletely on axons, or even peeled off at 15 h to 24 h. Perinuclear lysis of Nissl's bodies at 24 h after injury could be seen by Nissl body staining. The results indicated that, the pathological changes in injured brainstem could be observed with histochemical staining, which might be used for timing brainstem injuries.
Animals ; Axons/pathology* ; Brain Injuries/pathology* ; Brain Stem/injuries* ; Female ; Histocytochemistry ; Male ; Neurons/pathology* ; Rats ; Rats, Wistar ; Staining and Labeling

OBJECTIVETo investigate the antimicrobial resistance and penicillin resistance-associated genes (TEM and pbp2B) of Streptococcus pneumoniae (S. pneumoniae) isolated from sputum specimens of Guangzhou children with respiratory tract infection.

METHODSE-test and Kirby-Bauer methods were applied to detect the antibiotic susceptibility of 44 strains of S. pneumoniae. PCR was used to detect resistance genes pbp2B and TEM, followed by DNA sequence analysis of pbp2B gene. The sequence results were compared to those of penicillin-susceptible S. pneumoniae R6.

RESULTSOf the 44 isolates of S. pneumoniae, only 5 (11.4%) were susceptible to penicillin. All strains were resistant to erythromycin but susceptible to ofloxacin and vancomycin. The resistance rate of the isolates to clindamycin and trimoxazole was more than 90%. The S. pneumoniae isolates showed a high susceptibility to amoxicillin, imipenem and ceftriaxone, with a resistance rate of 0, 2.6% and 3.9%, respectively. The sequence analysis showed that more than 99% nucleotide sequence of pbp2B gene of five penicillin-susceptible isolates was the same as penicillin-susceptible S. pneumoniae R6, without any amino acid replacement. Site mutation was found in the remaining 39 penicillin-nonsusceptible isolates with a nucleotide mutation rate ranging from 13.2% to 23.1% and amino acid replacement rate from 6.5% to 10.9%. The 39 penicillin-nonsusceptible isolates were classified into 4 types according to the mutation site between Ser391 and Thr492 of pbp2B: type I (n=30), type II (n=7), type III (n=1) and type IV (n=1). No TEM gene was detected in all the 44 S. pneumoniae isolates.

CONCLUSIONSThe S.pneumoniae isolates from Guangzhou children with respiratory tract infection are resistant to penicillin and erythromycin. Amoxicillin and the third generation cephalosporin may be recommended for treating S. pneumoniae infection. The mutation of pbp2B gene plays an important role in the development of S. pneumoniae resistance to penicillin.

Aminoacyltransferases ; genetics ; Child, Preschool ; Drug Resistance, Bacterial ; genetics ; Female ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Penicillin Resistance ; genetics ; Penicillin-Binding Proteins ; genetics ; Respiratory Tract Infections ; microbiology ; Streptococcus pneumoniae ; drug effects ; genetics ; beta-Lactamases ; genetics

OBJECTIVETo observe the effect of Chinese drugs for strengthening Pi, harmonizing Wei, and dispersing blood stasis (CDSPHWDBS) on the expression of gastric mucosal heat shock protein 70 (HSP70) in chronic atrophic gastritis (CAG) patients.

METHODSA total of 100 CAG patients were assigned to the control group and the treatment group by random digit table, 50 in each group. Patients in the control group took Folic Acid Tablet 10 mg each time, 3 times per day. Those in the treatment group took CDSPHWDBS, 100 mL each time, once per day. The treatment course was 6 months for all. Clinical symptoms and signs, endoscopic and histopathological changes were observed before and after treatment in the two groups. The expression of gastric mucosal HSP70 in CAG patients was determined using SP immunohistochemistry. Data were collected by HPIAS-1 000 pathological graphic analysis system, and its expression semi-quantitatively analyzed.

RESULTSThe total effective rate of clinical Chinese medical symptoms and signs was 88. 0% (44/50 cases) in the treatment group and 56. 0% (28/50 cases) in the control group, with significant difference between the two groups (P <0. 01). The improvement rate of endoscopic manifestations such as congestion and edema, erosion, bile regurgitation, pale gastric mucosa, exposed blood vessels, particles proliferation in the treatment group were superior to those in the control group (P <0. 05). The total effective rate of atrophy was 80. 0% (40/50 cases) in the treatment group and 54. 0% (27/50 cases) in the control group, with significant difference between the two groups (P<0. 01). The effective rate of intestinal metaplasia was 75. 0% (12/16 cases) in the treatment group and 33.3% (5/15 cases) in the control group, with significant difference between the two groups (P < 0. 05). The optical density value of gastric mucosal HSP70 was significantly elevated in the two groups after treatment (both P <0. 05). It was higher in the treatment group than in the control group after treatment with significant difference (P <0. 01).

CONCLUSIONCDSPHWDBS had obvious effect in treatment of CAG and could improve pathological changes of precancerous lesions possibly by promoting the expression of gastric mucosal HSP70 in CAG patients.

Drugs, Chinese Herbal ; therapeutic use ; Gastric Mucosa ; metabolism ; Gastritis, Atrophic ; drug therapy ; metabolism ; HSP70 Heat-Shock Proteins ; metabolism ; Humans ; Immunohistochemistry ; Medicine, East Asian Traditional

Objective To observe the clinical efficacy of Xingnao Kaiqiao Acupuncture(with the functions of awakening the brain and opening the orifices)combined with acupuncture at pericardium meridian points in the treatment of post-stroke sleep reversal(PSSR).Methods Sixty patients with PSSR were randomly divided into observation group and control group,30 patients in each group.Both groups were given conventional treatment,the control group was given oral use of Alprazolam,and the observation group was given the combination of acupuncture a at pericardial meridian points,and 10 days of treatment was one course of treatment.After 10 days of treatment,the clinical efficacy of the two groups was evaluated.The changes in the Pittsburgh Sleep Quality Index(PSQI)and Ascens Insomnia Scale(AIS)scores,as well as the Hamilton Depression Scale(HAMD)scores were observed before and after treatment in the two groups.The changes in cortisol levels at 0,8,and 16 o'clock were compared before and after treatment between the two groups.Results(1)After treatment,the PSQI scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving PSQI scores,and the difference was statistically significant(P＜0.05).(2)After treatment,the AIS and HAMD scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the AIS and HAMD scores,and the difference was statistically significant(P＜0.05).(3)After treatment,the cortisol level of patients in the two groups at 0,8,and 16 o'clock was significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the cortisol level at 0,8,and 16 o'clock was significantly superior to the control group,and the difference was statistically significant(P＜0.05).(4)The total effective rate was 86.67%(26/30)in the observation group and 80.00%(24/30)in the control group.The efficacy of the observation group was slightly superior to that of the control group,but the difference was not statistically significant(P＞0.05).Conclusion Xingnao Kaiqiao Acupuncture combined with acupuncture at pericardium meridian points for the treatment of PSSR can significantly improve the clinical symptoms of the patients,so as to improve the quality of life of the patients,and the therapeutic efficacy is remarkable.