ObjectiveTo investigate the encountered life events in patients with tuberculosis within 1 year before the attack.MethodsThe encountered life events within 1 year before the attack were investigated in 85 patients with tuberculosis, the life event frequency (LEF) and life event intensity (LEI) were calculated respectively, and the life events were compared with those within 1 year in 55 healthy subjects.Results71 cases (83.5%) of the 85 patients with tuberculosis had encountered different life events within 1 year before the attack, which was significantly different from that in the control group (9 cases, 16.4%) (χ2=12.351,P<0.01 ). The LEF, negative LEF, average LEI, average negative LEI in the tuberculosis group before the attack were obviously higher than those in the control group (P<0.05～0.01), but there were no significant differences in the positive LEF and average positive LEI between the two groups (P>0.05).ConclusionThe encountered life events are closely correlated with primary tuberculosis, so more mental cares should be paid to the patients.

Objective To observe the efficacy and safety of the etomidate target controlled in-fusion (TCI)in the total thoracoscopic mitral valve replacement surgery.Methods One hundred and ten patients,aged 29-55 years,48 males and 62 females with ASA grade Ⅱ or Ⅲ rheumatic mitral valve disease planned to be corrected with total thoracoscopic mitral valve replacement surgery were randomly divided into group E and group P,55 cases in each group.In group E,etomidate-sufentanil target controlled infusion was used for induction (the initiate plasma concentration of etomidate was 0.2 ng/ml and increased 0.1 ng/ml per minute according to the bispectral index and the effect-site concentration of sufentanil was maintained at 1.0 ng/ml)and maintenance.In group P,using propo-fol-sufentanil target controlled infusion for induction (the initiate plasma concentration of propofol was 1.0 ng/ml and increased 0.3 ng/ml per minute according to the bispectral index and the effect-site concentration of sufentanil was maintained at 1.0 ng/ml)and maintenance.We documented the incidence of hypotension during the induction phase, recorded the basic clinical parameters of patients,the dosage of vasopressors during induction and sufentanil during anesthesia,time of eyelash reflex absence,operation time,CPB time,clamping time,APACHE Ⅱ score when enter CCU,pos-itive inotropic score 24 h postoperatively,wakening time,mechanical ventilation time,CCU stay,in-hospital stay,blood glucose and lactic acid preoperatively,2,6,24 h postoperatively,cortisol,aldo-sterone and adrenocorticotropin preoperatively and 24 h postoperatively and postoperative complications in both groups.Results The incidence of hypotension during induction in group E was much lower than that in group P (P<0.05).The dosage of norepinephrine during the induction in group E were much less than group P (P <0.05).The wakening time,mechanical ventilation time,CCU stay and in-hospital stay in group E were significantly shorter than group P (P <0.05).The blood glucose and lactic acid at postoperative 2,6,24 h were much higher than the preoperative value within each group (P <0.05).They reached the maxim at 6 h postoperatively and began to decline at 24 h postoperatively. Blood glucose and lactic acid at all the time points between two groups were similar.Cortisol at 24 h postoperatively was much higher than the preoperative value in group P (P <0.05).The dosage of cortisol and aldosterone 24 h postoperatively in group E were much less than that in group P (P <0.05).The incidence of postoperative lung infection in hospital in group E was remarkably lower than that in group P (P <0.05).Conclusion Etomidate target controlled infusion can maintain stable he-modynamics during the induction period, shorten postoperative recovery time and reduce postoperative lung infection obviously,which can be safely used in total thoracoscopic mitral valve re-placement surgery.

Objective To observe the efficacy of pregabalin in the treatment of painful diabeticperipheral neuropathy.Methods In a 8-week study,50 patients were randomly assigned into two groups:the therapy group and the control group.The patients in the therapy group were treated with pregabalin 150 mg/d,and the patients in the control group were treated with carbamazepine 200 mg/d.The dose of pregabalin was increased to 300 mg/d till pain was alleviated in the therapy group,and the dose of carbamazepine was increased to 600 mg/d till pain was alleviated in the control group.The therapeutic effect and VAS score in the two groups were observed and evaluated.Results After 1 and 8 weeks' treatment,the therapeutic effect of therapy group were significantly superior to the control group ( At 1 week:U =2.028,P =0.046 ; At 8 week:U =3.540,P ＜0.001 ).After 1 and 8 weeks' treatment,the VAS scores of therapy group were significantly lower than the control group ( At 1 week:5.13 ± 1.76 vs.6.74 ± 1.52,P ＜ 0.05 ; At 8 week:1.13 ± 0.45 vs 3.27 ± 1.04,P ＜ 0.05).There were 5 patients (20％) and 10 patients (40％) had adverse reaction in the therapy and the control groups respectively.Conclusion Pregabalin is effective and safe for the treatment of painful diabetic peripheral neuropathy.

Objective To study the correlation between novelty seeking(NS) personality of healthy young individuals and fractional anisotropy (FA) with voxel-based analysis (VBA) of diffusion tensor imaging(DTI),and explore the microstructure of white matter of personality.Methods Total 333 healthy right handed volunteers completed the Chinese version of the TPQ and the Beck Depression Inventory(BDI),and then finished 3D T1 structure scan,DTI scan.All preprocessed DTI datum was analyzed with SPM8 soft ware in partial correlation analysis,using age and depression scores as controlled variable.The correlation studied between NS and FA (a voxel significance threshold P ＜ 0.001 and a cluster extent threshold of 30 voxels).Results NS score of men and women were 14.55 ± 4.66 and 14.08 ± 5.42 points,and the difference between the two groups was not statistically significant (t =0.81,P=0.46).BDI score of men were higher than that of women (t =3.10,P=0.002),which were 9.23 ± 7.90 and 6.76 ± 5.79 points respectively.NS correlated negatively with FA of the right inferior frontal gyrus,and the right supramarg(i)nal gyrus(P ＜ 0.001).Conclusion NS personality has specific microstructure background of white matter.

Objective To compare the repeatability of radiotherapy placement between negative pressure vacuum pad (A group) and common soft pillow (B group) combined with a thermoplastic membrane immobilization technology in severe kyphosis patients with head and neck cancer.Methods From September 2013 to December 2014,22 cases of severe kyphosis patients with primary or secondary head and neck cancer who received radiotherapy were randomly divided into group A and group B.Padding waist hips with negative pressure vacuum pad and ordinary soft pillow were used so that the patients could lay in CT-Sim bed,and the head cushion was set on the headrest.After the fixing of thermoplastic head and neck shoulder membrane,CT-Sim was located.Every five times of radiotherapy were accompanied by CT-Sim school position once.In the direction of the last layer of right styloid process center point as the reference point,CT-sim software was used to measure the location change with left and right sides,head,and under direction (x,y,z,respectively) in patients,and the data were analyzed.Results Group A significantly reduced the osseous placement error between tags compared with group B (P ＜ 0.05).The average placement errors were as follows,x:(0.68±0.14) mm vs (1.15±0.77) mm,y:(0.48±0.23) mm vs (1.49±1.24) mm,z:(0.76±0.54) mm vs (2.11±1.02) mm,while the average transfer errors were as follows,x:(0.70±0.21) mm vs (1.15±0.93) mm,y:(0.50±0.31) mm vs (1.50±1.28) mm,z:(0.85±0.26) mm vs (1.77±0.88) mm.Conclusion Vacuum suction pad combined with thermoplastic membrane has good repeatability on radiotherapy positioning for severe kyphosis patients with head and neck cancer.

Objective To investigate the repeatability of precise radiotherapy placement of self-made adjustable angle wedge plate,negative pressure vacuum pad and conmon soft pillow,corresponding to 3 groups.The study is demonstrated with a thermoplastic membrane immobilization technology in kyphotic deformity patients with head and neck cancer (including primary and secondary),respectively.Methods From Jun 2014 to Apr 2016,48 cases of severe head and neck cancer patients received radiotherapy humpback who were randomly divided into 3 groups.Combined with thermoplastic head and neck shoulder film position fixation,the right foot direction at the end of the skull styloid process layer center was set as a reference point.On the left foot at the end of the direction of styloid process layer center,localization of the origin of the coordinate system in patients around the head and foot,dorsoventrally (x,y,z) analysis of the direction change of position measurement was performed.Results There was no significant difference between the adjustable angle wedge plate and negative pressure vacuum pad groups of the coordinate system (P ＞ 0.05).Compared with common soft pillow group,three dimensional positioning errors and three dimensional coordinate system transfer errors of the adjustable angle wedge plate and negative pressure vacuum pad groups were statistically significantly different (t =-6.99 to-2.69,-5.13 to-2.71,P＜0.05).Conclusions The self-made adjustable angle wedge plate has good repeatability,saves time and money,is simple and durable on precise radiotherapy positioning of kyphotic deformity patients with head and neck cancer.

Objective To investigate the effects of cleaning and disinfection of thermoplastic masks on the hospital infection in patients receiving precise radiotherapy for nasopharyngeal carcinoma ( NPC). Methods A prospective study was performed among 102 patients receiving precise radiotherapy for NPC from 2013 and 2016, consisting of 18 patients with early?stage ( I, Ⅱ) disease and 84 patients with advanced (Ⅲ, IV) disease. All patients were randomly divided into group A and group B using a random number table. For group A, the marker lines of thermoplastic masks were sandwiched by double plastic tapes;cleaning and disinfection plus ultraviolet ( UV ) disinfection were applied to the masks 1 h prior to radiotherapy and immediately after radiotherapy. For group B, only conventional UV disinfection was applied to the masks. The surface of the masks was examined and hospital infection during radiotherapy was evaluated. Results At the 18th radiotherapy, group A had a significantly lower mask surface colony count than group B (7.90±650 vs. 139.05±12929 CFU/cm2, P=0000). Group A also had a significantly lower incidence of hospital infection than group B (725% vs. 882%, P=0046). For the patients with early stage NPC, particularly, there was no significant difference in the incidence of infection between the two groups (556% vs. 667%, P=0629). For patients with advanced NPC, group A had a significantly lower incidence of infection than group B ( 762% vs. 929%, P=0035) . There were no significant differences in incidence rates of oral mucosal, skin, and respiratory system infections between the two groups ( 471% vs. 510%, P=0692;176% vs. 235%, P=0463;78% vs. 137%, P=0338) . In both groups A and B, the incidence of oral mucosal infection was significantly higher than the incidence rates of skin infection ( P=0001, 0000) and respiratory system infection ( P=0004, 0000) . Conclusions Thermoplastic mask is one of the risk factors for hospital infection in patients receiving precise radiotherapy for NPC. Timely cleaning and disinfection plus UV disinfection can significantly reduce the surface colony count and the incidence of hospital infection in patients with NPC, particularly in those with advanced NPC receiving precise radiotherapy. The incidence of hospital infection is the highest in the oral mucosa, followed by the skin and the respiratory system.

Objective To explore the effect and significance of clinical pathway guided teaching in the residency standard training program of respiratory medicine. Methods Total 47 resident physicians were selected and divided into clinical pathway group and control group from March 2014 to November 2014. The pathway group (n=24) was introduced into the teaching guided by clinical pathway management. The control group (n=23) was taught by traditional teaching method. All physicians were tested for the basic theory and the ability of case analysis after 4 weeks training. The ability of chemotherapy strategy ordered by residents independently and correctly was assessed each week during training. A satisfaction questionnaire survey was conducted to evaluate the effectiveness and satisfaction of teaching guided by clinical pathway. GraphPad Prism 5.0 was used and T test was done for comparison of data between groups. Results The medical records about basic theory and case analysis in the pathway group was higher than those in the control group with significant statistical difference (P<0.05). The records of resident physicians who could issue orders for chemotherapy independently and correctly were (70.75±2.79), (81.43±1.91), (85.23±1.3), (90.62±2.34) in the pathway group and (69.65±2.06), (77.11±2.21), (80.3±1.96), (87.78±2.21) in the control group at each week time point. There was statistical increase of the records in the pathway group than in the control group since the second week time point (P<0.05) The overall satisfaction of the pathway group was 95.84%(23/24), and the teaching satisfaction was higher than that of the control group(91.29%, 21/23). Pathway group doctors believe that the relevant teaching effectively improve the level of their knowledge , experience and ability. Conclusions The teaching method guided by clinical pathway is help-ful to standardize the teaching behavior, develop the standardized medical behavior of resident physicians, improve their clinical working ability efficiently, promote the relationship between teaching and studying, which is worth application in the residency standard training program of respiratory medicine.

Purpose To analyse the correlation between the Toll-like receptor 3 (TLR3) expression and clinic pathologic factors,stromal microenvironment in hepatocellular carcinoma (HCC).Methods The tissue microarrays of human HCC were prepared with self-owned patent technology.The expression of TLR3 in HCC cells as well as various indexes in HCC stroma was examined with immunohistochemistry of SP.The correlation between TLR3 expression with the clinic pathologic factors of HCC,and the correlation between TLR3 expression with the reaction of stromal cells in HCC microenvironment were analyzed by multi-factor correlation analysis.Results The positive expression rate of TLR3 in HCC was 71.57％.The expression of TLR3 in HCC had negative correlation with vascular invasion (P =0.001),cirrhosis (P =0.007),Edmondson's grades (P =0.001) and staging of TNM (P =0.000).It had positive correlation with hepatitis B surface antigen (HBsAg) (P =0.000).It had positive correlation with T cells (P =0.002) and natural killer (NK) cells (P =0.000).It had negative correlation with carcinoma-associated fibroblasts (CAFs) (P =0.000) and microvessel density (MVD) (P =0.000).Conclusion TLR3 has an important influence on the interstitial microenvironment of HCC.

Objective To evaluate the effect of losecplatin combined with compound matrine in the intraperitoneal perfusion treatment of ovarian cancer with malignant ascites and its influence on the levle of serum tumor necrosis factor alpha(TNF-) of ovarian cancer marker.Methods 60 ovarian cancer patients with malignant ascites were divided into three groups:losecplatin combined with compound matrine perfusion group(combination group),single losecplatin perfusion group(losecplatin group) and single compound matrine perfusion group(compound matrine group),20 cases in each group.Before treatment,all the three groups were drained intraperitoneal fluid,then given the above-mentioned group of intraperitoneal perfusion therapy.The effects,side effects and serum TNF- levels of the three groups were compared.Results The patients of the three groups were successfully completed treatment,the effective rate of the combination group was 95%,which of the losecplatin group was 60%,which of the compound matrine group was 55%.The effective rate of the combination group was significantly higher than that of the single drug group(χ2=7.025,P<0.05),and the adverse reaction of the combination group was not significantly increased(χ2=1.026,P>0.05).The serum TNF- levels of the three groups after the perfusion treatment were significantly decreased(t=15.40,13.82,8.90,all P<0.05),TNF- level of the combination group was significantly lower,the difference was statistically significant(F=9.719,P<0.05).Conclusion Losecplatin combined with compound matrine in the intraperitoneal perfusion is a more effective method for the treatment of ovarian cancer with malignant ascites,which is worthy of promotion.