Objective:To develop a training system for head and neck oncology nurses to improve the emergency response competency to recognize and response to acute and critical medical conditions.Methods:Based on literature review and semi-structured interviews with 12 nurses, two rounds of consultation with 15 head and neck cancer care specialists from 6 Tertiary hospitals using Delphi method were conducted to establish the training system for head and neck oncology nurses.Results:The authority coefficients of experts were 0.87 and 0.89, respectively. The coefficient of variation of each item ranged from 0 to 0.167. The coefficients of concordance ranged from 0.243 to 0.403 ( P<0.01). There was statistical significance after Chi-square test ( χ2 values were 14.60-436.64, all P<0.01). In the final training system, training aims included 5 first-level indicators and 16 second-level indicators; training contents included 5 first-level indicators, 16 second-level indicators, and 60 third-level indicators. Conclusions:The authority coefficients and the coefficients of concordance of the experts for the training system were both high. The training system can be applied to improve the emergency response competency of head and neck oncology nurses.

Insomnia has become a common central nervous system disease. At present, the pathogenesis of insomnia is not clear. Animal models can help us understand the pathogenesis of the disease and can be used in transformational medicine. Therefore, it is very necessary to establish an appropriate model of insomnia. Clinical data show that insomnia patients with high levels of thyroxine and often accompanied by cardiovascular problems, a common mechanism underlying all of these physiological disruptions is the sympathetic nervous system. Combined with the characteristics of chronic onset of clinical insomnia, an insomnia model induced by long-term intraperitoneal injection of thyroid hormone has been created in our laboratory. In this paper, the insomnia-like state of the model was evaluated based on three validity criteria. Face validity has been demonstrated in metabolism, the Morris water maze, electrocardiogram (ECG) and electroencephalogram (EEG). Structure validity has been proved by the results of targeted metabolomics. After treatment with diazepam, a commonly used clinical anti-insomnia drug, the above physiological and pathological disorders were reversed. The results of comprehensive analysis show that the established thyrotoxicosis-associated insomnia model meets the validity requirement to establish an appropriate animal model of insomnia. The model presented in this article might help to study pathogenetic mechanisms of clinical insomnia, as well as to test promising methods of insomnia treatment.

A 65-year-old male patient was treated with pyridostigmine bromide tablets (30 mg thrice daily), azathioprine tablets (75 mg twice daily), and prednisone acetate tablets (15 mg once daily) for myasthenia gravis. Two months later, the patient developed abdominal pain, nausea, and vomiting. The laboratory tests showed the blood lipase (LPS) 909 U/L and the urine amylase (AMS) 3 838 U/L. The results of abdominal ultrasonography and imaging examination were consistent with the manifestations of pancreatitis. Above-mentioned drugs were not stopped and the patient was treated according to the conventional treatment regimen of acute pancreatitis. However, the symptoms did not improved significantly. On the 11th day after the onset of the disease, he received subcutaneous infusion of octreotide injection, intravenous infusion of pantoprazole sodium for injection, oral metronidazole, and supportive treatments such as fluid supplement and correction of water electrolyte disorders. The laboratoty tests the next day showed that the patient′s blood LPS was 3 332 U/L and AMS was 139 U/L. The acute pancreatitis was considered to be related to azathioprine tablets. Then the drug was stopped and other treatments were continued. The patient′s symptoms improved quickly. Four days later, LPS was 546 U/L and AMS was 49 U/L.

A 65-year-old male patient was treated with pyridostigmine bromide tablets (30 mg thrice daily), azathioprine tablets (75 mg twice daily), and prednisone acetate tablets (15 mg once daily) for myasthenia gravis. Two months later, the patient developed abdominal pain, nausea, and vomiting. The laboratory tests showed the blood lipase (LPS) 909 U/L and the urine amylase (AMS) 3 838 U/L. The results of abdominal ultrasonography and imaging examination were consistent with the manifestations of pancreatitis. Above-mentioned drugs were not stopped and the patient was treated according to the conventional treatment regimen of acute pancreatitis. However, the symptoms did not improved significantly. On the 11th day after the onset of the disease, he received subcutaneous infusion of octreotide injection, intravenous infusion of pantoprazole sodium for injection, oral metronidazole, and supportive treatments such as fluid supplement and correction of water electrolyte disorders. The laboratoty tests the next day showed that the patient′s blood LPS was 3 332 U/L and AMS was 139 U/L. The acute pancreatitis was considered to be related to azathioprine tablets. Then the drug was stopped and other treatments were continued. The patient′s symptoms improved quickly. Four days later, LPS was 546 U/L and AMS was 49 U/L.

The study aimed to establish a population pharmacokinetic/pharmacodynamic (PPK/PD) model of warfarin. PCR-RFLP technique was used to genotype the CYP2C9 and VKORC1 polymorphisms of 73 patients. RP-HPLC-UV method was used to determine the 190 plasma concentrations of warfarin. Application of NONMEM, the clinical information and 263 international normalized ratio (INR) monitoring data were used to investigate the effect of genetic, physiological, pathological factors, other medication on clearance and anticoagulant response. The final model of warfarin PPK/PD was described as follows: CL = θCL · (WT/60)θWT · θCYP · eηCL (if CYP2C9*1/*1, θCYP = 1; if *1/*3, θCYP = 0.708); EC50 = θEC50 · θVKOR · eηEC50 (if VKORC1- 1639AA, θVKOR = 1; if GA, θVKOR = 2.01; V = θV; K(E0) = θK(E0); Emax = θEmax; E0 = θE0 · eηE0. Among them, the body weight (WT), CYP2C9 and VKORC1 genotype had conspicuous effect on warfarin PK/PD parameters. The goodness diagnosis, Bootstrap, NPDE verification showed that the final model was stable, effective and predictable. It may provide a reference for opitimizing the dose regimen of warfarin.

Objective To compare the accuracy of Marsh model and Schnider model for propofol target?controlled infusion ( TCI) system. Methods Eighty patients, aged 20-60 yr, of American Society of Anesthesiologists physical status ⅠorⅡ, with body mass index of 17?5-28?0 kg∕m2 , scheduled for e?lective gynecological operation under general anesthesia, were equally and randomly divided into either Marsh model group ( group M) or Schnider model group ( group S) using a random number table. The target plasma concentration was set at 3 μg∕ml in both groups. During TCI and at different time points after the end of TCI, the blood samples were collected for determination of blood propofol concentrations by high per?formance liquid chromatography with fluorescence detector. The difference between measured and predicted concentrations (△C) at each time point was calculated. The median performance error ( MDPE) , median absolute performance error ( MDAPE) , and wobble of propofol TCI system were calculated in each group. Results In M and S groups, the MDPE was 9. 90% and 14?00%, respectively; the MDAPE was 11?43% and 14?49%, respectively;the wobble was 7?77% and 7?79%, respectively. There was no sig?nificant difference in △C at each time point during TCI between group M and group S (P>0?05). After TCI was stopped, △C at each time point was significantly lower in group M than in group S ( P<0?05) . Conclusion Marsh model provides higher accuracy than Schnider model for propofol TCI system in the pa?tients undergoing gynecological operation.

Objective To examine the differences in the structure of brain white matter among deficit schizophrenia, nondeficit schizophrenia and healthy controls by using voxel-based morphometry (VBM). Methods Ten deficit schizophrenic patients, eleven nondeficit patients and fifteen healthy comparison subjects participated in the study. All the subjects were scanned by GE Twin Speed 1.5T MRI system. Whole brain, voxel-wise analyses of regional white matter volume were conducted by the VBM toolbox on the Matlab7.6 and SPM5. t -test was then used for the comparison between groups. Results Compared to the healthy controls, nondeficit schizophrenic patients significantly decreased the density of gray matter in the frontal, parietal, temporal, occipital lobe and basal ganglia , while the deficit patients showed the characteristically broad and significant decreasion in the frontal lobe, including left medial frontal gyrus, bilateral inferior frontal gyrus, left middle frontal gyrus, and left orbital gyrus (Cluster ≥ 30 mm3, P<0.01). Moreover, deficit patients showed the decreasion in the temporal cortex and the limbic lobe (right insula). Relative to the nondeficit schizophrenic patients, deficit patients had significant regional gray matter decreases in the left medial frontal gyrus, bilateral inferior frontal gyrus, right precentral gyrus, and right superior temporal gyrus (Cluster ≥ 30 mm3, P<0.01). Conclusion Structural heterogeneity in schizophrenia may relate to specific patterns of gray matter density reductions in deficit and nondeficit patient. However the two subtype of schizophremia patients share a common prefrontal-temperal pattern of structural brain alterations.

The paper is to report the establishment of a population pharmacokinetic model for flurbiprofen (FP), an active metabolite of flurbiprofen axetil (FA). 246 FP serum concentration and clinical data were perspectively collected from 23 general anaesthesia patients receiving FA intravenously before operation in Dentofacial Surgery and Otorhinolaryngology Department of the First Affiliated Hospital of Fujian Medical University. Population pharmacokinetic data analysis was performed using NONMEM software. The measure of Bootstrap was applied for internal validation, while Visual Predictive check was adopted for external validation. The data of FP correspond with two-compartment model. The body weight (WT) had conspicuous effect on clearance and volume of central compartment, while sex, age and daily dose of administration had no marked effect on pharmacokinetic parameter of FP. The basic model was described as follows: CL (L x h(-1)) = 1.28x EXP(ETA(1)), V1 (L) = 5.03x EXP(ETA(2)), Q (L x h(-1)) = 8.5 x EXP(ETA(3)), V2 (L) = 4.39 x EXP(ETA(4)). The final model was described as follows: CL (L x h(-1)) = 1.32 x (WT/60) x EXP(ETA(1)), V1 (L) = 5.23 x (WT/60) x EXP(ETA(2)), Q (L x h(-1)) = 8.45 x EXP(ETA(3)), V2 (L) = 4.37 x EXP(ETA(4)). The population typical value of CL, V1, Q and V2 were: 1.32 L x h(-1), 5.23 L, 8.45 L x h(-1) and 4.37 L, respectively. Bootstrap and visual predictive check show that the final model of FP is stable, effective and predictable. A novel population pharmacokinetic model is developed to estimate the individual pharmacokinetic parameter for patients intravenous injecting FA in terms of patients' characteristics and dosing history, and to design a prior dosage regimen.

OBJECTIVE:To investigate the compatible stability of isosorbide mononitrate(ISO) and dopamine(DA) hydrochloride in glucose injection.METHODS:The contents of ISO and DA in the mixture of ISO and DA at 20 ℃ and 30 ℃ under natural illumination within 24 h,and the pH and appearance of the mixture were monitored.RESULTS:No significant change was noted in the concentrations of ISO and DA,the pH and the appearance of the mixture at 20 ℃ or 30 ℃.CONCLUSION:The mixture of ISO and DA in glucose injection was stable at 20 ℃ or 30 ℃,but which should be used up within 18 h after mixing.

Objective To observe the effect of Chinese medicine Qingre Huoxue Xiaozhong Ⅰ/Ⅱ mixture on the knee joint function disorder after fracture.Methods 143 patients with knee joint function disorder after fracture were randomly divided into the treatment group(n=50),control Ⅰ group(n=48),control Ⅱ group(n=45).The cases of the treatment group were treated with Qingre Huoxue Xiaozhong Ⅰ mixture 150 ml three times per day orally,Qingre Huoxue Xiaozhong Ⅱ mixture exteral washing once every day,and combined with Honghua oil and TDP instrument therapy.The cases of the control Ⅰ group were treated with the prepared medicine Shenjin Dan 6 pieces,three times a day,combined with Honghua oil and TDP instrument therapy.The cases of the control Ⅱ group were treated only with Honghua oil and TDP instrument therapy.15 days were as a treatment course,and performed 1～2 treatment courses.The patients of the three groups also took the vitamins and calcitium simultaneously.The curative effect was evaluated according to the standard of Lysholm Joint Function.Results After treatment,the total excellent rates of the treatment group,control Ⅰ group and control Ⅱ group were 78%,39.58% and 24.44%,respectively,the result of the treatment group was significantly superior to that of the control Ⅰ group and control Ⅱgroup(P<001).The total effective rates of the treatment group,control Ⅰ group and control Ⅱ group were 98%,85.42% and 75.55%,respectively.The effect of the treatment group was also significantly superior that of the control Ⅰ group(P<0.05) and control Ⅱ group( P<0.01).Conclusion The Chinese native medicine Qingre Huoxue Xiaozhong Ⅰ/Ⅱ mixture has an obvious therapeutic effect in the multidisciplinary therapies on the knee joint function disorder after fracture.