Construction of multi-level medical training platform system in clinical skills simulation training center / 中华医学教育探索杂志

This study mainly introduces the exploration of the construction and management of multi-level medical training platform in clinical skills center of the Affiliated Hospital of Yangzhou University. Through the construction of a multi-level clinical skills training platform, a reasonable hierarchical training program is formulated by taking the clinical basic skills training platform and the clinical specialist skills training platform as the basic core teaching content. This program adopts various ways to improve the teaching quality, effectively promote students' ability of clinical practice step by step, meet the needs of different levels of medical personnel in different stages, scientifically and effectively cultivate the high-quality medical personals, and give full play to the role of hospital clinical skills center in medical education, which lays a good foundation for the continuous improvement of teaching quality in hospitals.

Breath-by-breath measurement of exhaled ammonia by acetone-modifier positive photoionization ion mobility spectrometry via online dilution and purging sampling / 药物分析学报

Exhaled ammonia(NH3)is an essential noninvasive biomarker for disease diagnosis.In this study,an acetone-modifier positive photoionization ion mobility spectrometry(AM-PIMS)method was developed for accurate qualitative and quantitative analysis of exhaled NH3 with high selectivity and sensitivity.Acetone was introduced into the drift tube along with the drift gas as a modifier,and the characteristic NH3 product ion peak of(C3H6O)4NH4+(K0=1.45 cm2/V·s)was obtained through the ion-molecule reaction with acetone reactant ions(C3H6O)2H+(K0=1.87 cm2/V·s),which significantly increased the peak-to-peak resolution and improved the accuracy of exhaled NH3 qualitative identification.Moreover,the interference of high humidity and the memory effect of NH3 molecules were significantly reduced via online dilution and purging sampling,thus realizing breath-by-breath measurement.As a result,a wide quantitative range of 5.87-140.92 μmol/L with a response time of 40 ms was achieved,and the exhaled NH3 profile could be synchronized with the concentration curve of exhaled CO2.Finally,the analytical capacity of AM-PIMS was demonstrated by measuring the exhaled NH3 of healthy subjects,demon-strating its great potential for clinical disease diagnosis.

Application of ultrasound in predicting difficult laryngoscopy in children / 临床麻醉学杂志

Objective To compare the effect of ultrasound measurements of the distance from skin to vocal folds (DSV), neck diameter (d) and the ratio among the two measurements (R) used to predict difficult laryngoscopy. Methods Seventy-two toddelers scheduled to undergo general anesthesia, aged ≤ 3 years, falling into ASA physical status Ⅰ or Ⅱ, were included and categorized as having easy (n = 48, grades Ⅰ and Ⅱ) or difficult (n = 24, grades Ⅲ and Ⅳ) laryngoscopy based on the criteria of Cormack and Lehane. When children were ventilated by mask, we measured DSV by ultrasound; obtained d and R. Receiver operating characteristic (ROC) curve analysis was used to determine the DSV, d and R in predicting difficult laryngoscopy. The value of cutoff was obtained by maximizing the Youden's index. Results DSV was significantly shorter in difficult laryngoscopy group (P ＜ 0.05). The areas under the ROC curve of R was 0.807, and the cutoff value was 0.090. the sensitivity was 70.83％, the specificity was 83.33％ Conclusion The ratio of distance from skin to vocal folds to neck diameter is a good predictor of difficult laryngoscopy in children under 3 years old.

Efficacy of routine extraluminal use of Arndt endobronchial blocker for one-lung ventilation in infants / 中华麻醉学杂志

Objective To evaluate the efficacy of routine extraluminal use of an Arndt endobronchial blocker (AEB) for one-lung ventilation (OLV) in infants.Methods Thirty American Society of Anesthesiologists physical status Ⅰ or Ⅱ infants,aged 6-36 months,weighing 5-18 kg,undergoing elective thoracoscopic surgery,were enrolled in the study.The loop of AEB was fastened to the front of the endotracheal tube (ETT),and the blocker was placed externally to the ETT.After induction of general anesthesia,the AEB's placement was facilitated through the use of a fibreoptic bronchoscope.Mean arterial pressure,heart rate,end-tidal pressure of carbon dioxide,oxygen saturation and airway pressure were recorded before AEB placement (T1),during AEB placement (T2),at the beginning of OLV (T3),at the beginning of two lung ventilation (T4) and at extubation (T5).The AEB placement time and successful placement and lung collapse time were recorded.The satisfaction with lung collapse,AEB shifting,hoarseness and development of intraoperative adverse cardiovascular events and hypoxemia and hypoventilation during OLV were recorded.Results Compared with the baseline at T1,no significant change was found in heart rate or mean arterial pressure at the other time points (P＞ 0.05),airway pressure was significantly increased at T2,3,and end-tidal pressure of carbon dioxide was increased at T4 (P＜0.05).The AEB placement time was (5.6± 1.2) min,the success rate of AEB placement 93％,the rate of satisfaction with lung collapse 83％,and the incidence of AEB shifting (only found in the pediatric patients in whom AEBs were placed on the right side) 13％.No intraoperative adverse cardiovascular events,hypoxemia or hypoventilation was observed in the pediatric patients in whom AEBs were successfully placed.Conclusion Routine extraluminal use of an AEB can provide a fast,safe and effective method for OLV in infants.

Efficacy of closed-loop infusion of propofol for surgery on body surface in preschool and school-age pediatric patients / 中华麻醉学杂志

Objective To evaluate the efficacy of closed-loop infusion of propofol for surgery on the body Surface in preschool and school-age pediatric patients.Methods American Society of Anesthesiologists physical status Ⅰ pediatric patients of both sexes,undergoing elective surgery on the body surface,were included in the study.One hundred twenty-four preschool pediatric patients (aged 3-6 yr) were divided into 2 groups (n=62 each) using a random number table:closed-loop group (CPRE group) and openloop group (OPRE group).Thirty-eight school-age pediatric patients (aged 7-12 yr) were divided into 2 groups (n=19 each) using a random number table:closed-loop group (CSTU group) and open-loop group (OSTU group).The target bispectral index (BIS) value was set at 50 during maintenance of anesthesia.Propofol was delivered using closed-loop anesthesia delivery system,and the target plasma concentration of propofol was automatically regulated in CpRE and CSTU groups.Propofol was given using open-loop anesthesia delivery system,and the target plasma concentration of propofol was manually regulated in OpRE and OSTU groups.The adequate anesthesia time ratio (BIS40-60％) and global score (GS) of the delivery system were recorded during maintenance of anesthesia.The consumption of propofol,frequency of regulation and mean BIS value were recorded.The delivery system-related complications were recorded during the perioperative period.Results Compared with group OpRE,the consumption of propofol,GS and mean BIS value were significantly decreased,BIS40-60％ was increased (P＜0.05),and no significant change was found in the frequency of regulation in group CpRE (P＞0.05).Compared with group OSTU,GS was significantly decreased,BIS40-60％ was increased (P＜0.05),and no significant change was found in the consumption of propofol,mean BIS value or frequency of regulation in group CSTU (P＞0.05).Compared with group CpRE,the consumption of propofol and GS were significantly decreased,BIS40-60％ was increased (P＜0.05).and no significant change was found in the mean BIS value or frequency of regulation in group CSTU (P＞0.05).One pediatric patient in group CSTU developed airway spasm,and no severe complications were found in the other pediatric patients.Conclusion For surgery on the body surface in preschool and school-age pediatric patients,closed-loop infusion of propofol is safe and effective,the stability and precision of anesthesia is superior to that of open-loop anesthesia delivery system,and it provides better efficacy in school-age pediatric patients than in preschool pediatric patients.

Increased Expressions of Plasma Galectin-3 in Patients with Amyotrophic Lateral Sclerosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>High expressions of galectin-3 were identified recently in the end stage of amyotrophic lateral sclerosis (ALS) patients, which suggested that immune reactivity and inflammatory mechanisms might play an important role in the pathogenesis of ALS. The purpose of this study was to investigate plasma galectin-3 levels in different groups and stages of ALS patients and the association with related clinical characteristics.</p><p><b>METHODS</b>A total of 51 patients with ALS and 60 normal controls (NCs) were recruited in this study. Plasma galectin-3 levels were determined using the enzyme-linked immunosorbent assay. Patients with ALS were divided into several groups according to their clinical characteristics: gender, type of disease onset, duration of disease, and clinical conditions of disease. Statistical analyses of the differences of galectin-3 levels between groups and the association with the clinical characteristics of disease were performed.</p><p><b>RESULTS</b>As compared with the NCs (201.64 [22.35-401.63] ng/ml), plasma galectin-3 levels were significantly elevated in the patients with duration >12 months (341.17 [69.12-859.22] ng/ml, P< 0.05), and the patients with limb onset of disease (254.14 [69.12-859.22] ng/ml, P< 0.05); however, no difference was found in the patients with duration ≤12 months (250.62 [109.77-334.92] ng/ml, P > 0.05), and the patients with bulbar onset of disease (251.79 [109.20-404.76] ng/ml, P > 0.05). In addition, galectin-3 levels were significantly increased in the female patients (263.27 [123.32-859.22] ng/ml, P< 0.05) while no difference was found in the male patients (220.39 [69.12-748.73] ng/ml, P > 0.05). The further statistical analyses showed that plasma galectin-3 levels were positively correlated with the duration of disease (r = 0.293, P = 0.037).</p><p><b>CONCLUSIONS</b>Plasma galectin-3 levels were significantly increased in ALS patients with limb onset of disease, especially in ALS female patients, and positively correlated with the duration of disease, which suggested that plasma galectin-3 might be an interesting and useful factor associated with ALS.</p>

The study of anticoagulants selection in platelet-rich plasma preparation / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of the anticoagulants on PRP quality, so as to clarify the appropriate anticoagulant used in PRP production.</p><p><b>METHODS</b>The microstructure change of platelets collected via heparin, citrate, acid citrate dextrose (ACD) and citrate-theophylline-adenosine-dipyridamole ( CTAD) was observed by TEM following time course. The extent of spontaneous activation of platelets in four groups was detected by measuring sP-selectin in plasma. The TGF-β1 release amount of activated PRP of four groups was measured.</p><p><b>RESULTS</b>CTAD is superior to other anticoagulants in maintaining the integrity of platelet structures for a long time and preventing platelet spontaneous activation. ACD slightly surpassed heparin and citrate in above two aspects. ACD-PRP and CTAD-PRP released significantly more TGF-β1 compared with heparin and citrate.</p><p><b>CONCLUSIONS</b>The PRP quality and biological effects were strongly associated with the type of Anticoagulants. ACD and CTAD are optimal anticoagulants in PRP production for they can maintain platelet viability at a high level.</p>

Progress of pathogenesis about acute traumatic coagulopathy / 国际外科学杂志

Traumatic coagulopathy is a serious complication of tissue damage caused by trauma.In clinic,it easily develops into multiple system organ failure and results in high mortality.Traumatic coagulopathy is a plurality of blood coagulation disorder,its pathogenesis is extremely complex and involves tissue damage,blood coagulation,anticoagulation and fibrinolysis,inflammation and many other pathophysiological aspects.An in-depth study on the pathogenesis of traumatic coagulopathy is very important to improve clinical effect.This paper tries to do a review of recent study progress from pathophysiological mechanisms and hopes to provide reference for clinical work.

Practice and Ethical Considerations on the leading role of Party Organizations in carrying forward the Hospital Spirit / 中国医学伦理学

The hospital spirit is not only the spiritual support and vital source for staff, but also the concentrat-ed expression of ideology and faith, value orientation, moral trait, psychology tendencies, culture stereotypes, the unified will and code of conduct for all kinds of personnel.The party organizations are the best helmsmen to culti-vate and carry forward the hospital spirit, which reveals distinctive and profound medical ethical principles and norms.In this paper, taking X hospital as an example, we describe the core function of the party committee′s lead-ership and results in the process of breeding, inheritance and innovation of hospital spirit and reflect ethically so as to provide good references for the current hospital spirit cultivation and promotion.

Determination of Six Alkaloids in Crude and ProcessedRhizomaCoptidisby HPLC / 世界科学技术-中医药现代化

An HPLC method to determine six alkaloids of the Coptidis for Chinese Pharmacopoeia of 2015 Edition was established through C18 column. The mobile phase was CH3CN-0.25 mol·L-1 NH4Ac (36:64) (containing 8 mmol·L-1 SDS and adjusting pH 9.3 with ammonia) at the flow rate of 1 mL·min-1, the detective wavelength was 270 nm and the column temperature was 35 oC. The linear ranges of jatrorrhizine hydrochloride, columbamine hydrochloride, epiberberine hydrochloride, coptisine hydrochloride, palmatine hydrochloride and berberine hydrochloride were 0.006 96-0.233, 0.004 75-0.152, 0.003 30-0.528, 0.006 31-1.010, 0.004 71-0.753, 0.017 8-2.884 μg·mL-1, respectively. The average recoveries were 99.65%, 98.59%, 98.49%, 98.66%, 98.64%, 98.63% and RSD were 0.03%、0.15%、0.21%、0.12%、0.28%、0.23%, respectively. The method is simple and accurate, and can be used to determine the contents of jatrorrhizine, columbamine, epiberberine, coptisine, palmatine and berberine in the Coptidis.

Acetone-Enhanced Negative Vacuum Ultraviolet Photoionization Mass Spectrometry for Rapid Detection of Explosives / 分析化学

In this article, an acetone-enhanced negative photoionization (AENP) source based on a 10. 6 eV vacuum ultraviolet ( VUV) lamp was developed and coupled to a home-made time-of-flight mass spectrometer for rapid detection of trace explosives. In the AENP source, acetone molecules absorbed 10. 6 eV photons and were ionized by single photon ionization to emit photoelectrons. The photoelectrons reacted with O2 , CO2 , etc. in the atmosphere to produce mainly CO-3 negative reactant ions. With this ionization source, common explosives, N-nitrobiz ( 2-hyolorolroxy ethyl )-amine dinitrate ( DINA ) , Tetryl, trinitrotoluene ( TNT ) and hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), could be detected sensitively, and the limit of detection of 2 pg ( TNT) with a linear range of 3 orders of magnitude was achieved. The simple structure, high sensitivity characteristics make the AENP source as a promising ionization source for mass spectrometry.

Simultaneous determination of six triterpene acids in solid dispersion tablets of eriobotryae folium total triterpenoid acids by HPLC-ELSD / 中国药学杂志

OBJECTIVE: To establish a method for determination of six triterpene acids in solid dispersion tablets of Eriobotryae Folium total triterpenoid acids by HPLC-ELSD.

Analysis of the platelet counting difference between optical method and electrical impedance method and the alarm information of instrument / 国际检验医学杂志

Objective To compare the differences of platelet(PLT) count between the optical method (PLT‐O) and electrical impedance method (PLT‐I) ,using microscopic method (PLT‐M) as a standard method ,and to analyze the alarm information of in‐strument .Methods Both of PLT‐O and PLT‐M of 468 cases of patient specimens were detected by Sysmex XE‐2100 automatic hematocyte analyzer ,and which were compared with PLT‐M .The counts and morphology of red blood cells and platelets were de‐tected by microscopic method .The alarm information of red blood cells and platelets were recorded .Results In non‐hematopathy group ,there was no significant difference among PLT‐M ,PLT‐I and PLT‐O (P=0 .071) .In hematopathy group ,PLT‐I was signifi‐cantly different from both PLT‐M and PLT‐O (P0 .05) .There were 149 cases occurring platelets alarm and 127 cases occurring red blood cells alarm in hematopathy group , which was consistent with the results of microscopic method .Conclusion When the value of PLT is below the normal reference range ,counting error of PLT‐I is large and the value of PLT should be rechecked or corrected using PLT‐M and PLT‐O .Re‐exam‐ination should be performed when alarm information is displayed .

Euphorbia kansui roots induced-diarrhea in mice correlates with inflammatory response / 中国天然药物

AIM@#Euphorbia kansui (E. KS) is a traditional medicine used in China for thousands of years with the effect of propulsion in the gastrointestines. However, there is no reported study of E. KS on gastrointestinal motility until now. The aim of this work is to study the effect of E. KS on the propulsion of gastrointestines, and to elucidate the possible mechanism of action.@*METHODS@#E.KS was prepared as a 30% ethanol extract and used for the experiment of small and large intestines of mice by oral administration with three different dosages (1.2, 0.6 and 0.3 g·kg(-1)). The feces were observed in vivo. The morphology was carried out to detect if there are any changes in the intestines after the extract of E. KS administration. The assays of mRNA and protein expression were employed to observe IL-1β, TNFα and caspase 3.@*RESULTS@#It was shown that the extract of E.KS promoted diarrhea in mouse feces after administration, inhibited the contraction of smooth muscle of mouse small intestine and caused the inflammatory exudation on the mucosa of the intestines, enhanced the expression of both mRNA and the protein levels of IL-1β and TNFα in the small or large intestines.@*CONCLUSION@#The results showed that the extract of E. KS acted on the intestinal smooth muscle with propulsion of feces involving the irritation of the intestines with acute inflammatory reactions.

"Spearhead role of grassroots party organizations in ""hospital volunteer service"" campaign" / 中华医院管理杂志

Grassroots organizations of the party function as the center to advocate voluntary services.The hospital volunteer service campaign is considered part of the party's work at the grassroots level and as an indicator of its branch appraisal.volunteer ambassadors are employed to serve as role model for volunteer services.Party branch guides volunteer service teams to carry out voluntary services.And students,retiree party members actively participate in the campaigr.Outstanding ones are awarded and the management is improved.All these measures enable these organizations to play a spearhead role,encouraging volunteers and party members to promote each other,promoting healthy development of the campaign,and making volunteer services sustainable.

Induction of acute myelogenous leukemia cell apoptosis by bortezomib and its effect on SALL4 gene expression / 中国药学杂志

OBJECTIVE: To investigate the proteasome inhibitor bortezomib induces acute myelogenous leukemia cell lines TF1 and NB4 apoptosis and its effect on SALL4 gene expression. METHODS: Cell proliferations were analyzed by MTT assay. Flow cytometry was used to analyze cell apoptosis rate. SALL4 protein was detected by immunocytochemistry. The expressions of SALL4 gene were detected by Real-time PCR. SALL4 proteins in two cell lines were detected by Western Blotting. RESULTS: MTT assay showed bortezomib inhibited the proliferations of two cell lines in a time-and-does manner. TF1 and NB4 cells' 48 h IC50 were (29.15 ± 0.55) and (30.55 ± 0.74) nmol · L-1 respectively. Flow cytometry showed bortezomib could induce apoptosis of two cell lines in a dose-dependent manner. Immunocytochemistry analysis revealed that both of two cell lines expressed SALL4 proteins which located in cell nucleus. Real-time PCR demonstrated that SALL4 genes were down-regulated after cells were treated by different concentrations(10, 30, 50 nmol · L-1) of bortezomib for 24 h, and bortezomib 50 nmol · L-1 groups' genes were down-regulated to 45.11% (TF1) and 69.77% (NB4) respectively comparing with the control groups (P < 0.05). Western blotting revealed that both of the cell lines expressed SALL4B proteins and which could be inhibited by bortezomib in a time-and-does manner. CONCLUSION: Bortezomib can significantly inhibit two cell lines proliferation and induce apoptosis, meanwhile down-regulate the expressions of SALL4 gene. Copyright 2012 by the Chinese Pharmaceutical Association.

Effect of Euphorbia kansui on urination and kidney AQP2, IL-1beta and TNF-alpha mRNA expression of mice injected with normal saline / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of Euphorbia kansui (E. KS) alcohol extracts on urination and kidney-related expressions of mice injected with normal saline and to discuss its impact on kidney.</p><p><b>METHOD</b>Mice intraperitoneally injected with normal saline were observed for urination and changes in kidney-related histiocytic factors of after intragastrical administration of E. KS and compared with normal mice.</p><p><b>RESULT</b>E. KS alcohol extracts can promote urination of mice injected with normal saline and enhance peripheral serum creatinine, with no obvious pathological change showed in tissue sections. It had a certain effect on reducing AQP2 expression and enhancing TNF-alpha expression.</p><p><b>CONCLUSION</b>Euphorbia kansui in large dose has a remarkable effect on kidney but may be accompanied with pathological reactions to some extent, especially the dose of 1.2 g x kg(-1). The pathological reactions may be related with increased serum creatinine and TNF-alpha expression.</p>

An analysis of characteristic occupational stressors for medical staff in general hospitals / 中华医院管理杂志

Objective To explore the status, characteristics and factors in relation to occupational stress for medical staffs in tertiary general hospitals. Methods A total of 2460 medical staff were sampled in five tertiary general hospitals in Beijing, with their occupational stress levels evaluated with the Occupational Stress Inventory. Results The top ten stressors as found ranked as heavy duty, high risk exposure, high workload, low wages, setbacks in the health care management system, insufficient staffing, excessively frequent inspections and examinations, strained doctor-patient relationship, price inflation, frequent overtime, and pressure from continuous learning. Occupational stress is seen as moderate and above by 95.2% of the surveyed. Differences in age, gender, marital status, professional title, education, work experience, as well as those of different organizations, departments, professions, and duty were found to be statistically significant in regard of professional stress. Conclusions Stress management should be in place targeting demographic and stress characteristics. Effective measures are recommended to alleviate the pressure on medical staff, in order to maintain their physical and mental health, hence improving their work efficiency and organizational cohesion.

Survey of mental health and social support of medical staff in general hospitals / 中华医院管理杂志

Objective To probe into the social support, coping styles, and mental health status of medical staff in a tertiary hospital in Beijing, for identifying potential mental problems. Methods Such means as the Social Support Rating Sheet (SSRS), Simple Coping Style Questionnaire (SCSQ), Symptom Checklist (SCL-90), and demographic characteristics questionnaire were called into play, to study 2460 medical staff in five tertiary hospitals in Beijing. Results Differences were identified among medical staff of different demographic characteristics, in terms of positive coping style and support dimensions. Analysis of the survey data indicates that the total SCL scores, total symptom problem index, positive symptom pain level, total average score of the factors, are positively related to passive coping style, as P<0. 01; and are negatively related to subjective/objective support, support utilization, and total support scores, as P<0. 01. Conclusions Hospital administration is expected to implement focused intervention to such medical staff as those under 40 years old, women, widows or divorcees, those with education lower than university degree, those with junior academic title or lower, those without titles, those in emergency departments and emergency intensive care units, doctors and nurses, frequent night-shift workers, those of excessively low self evaluation, and medical staff with chronic diseases. The purpose of this practice is to alleviate their mental stress.

A study on the treatment of tension-free repair and traditional hernia repair of inguinal hernia in aged patients / 中国基层医药

Objective To compare tension-free repair and traditional hernia repair of inguinal hernia in the elderly patients. Methods During the period from 2000 to 2001,84 aged patients of scheduled for repair of inguinal hernia were randomized to tension-free repair or traditional hernia repair. The patients were followed up for two years. Results Tension-free repair of inguinal hernia was a simple procedure causing less trauma and operative time, fewer complications and recurrence. Conclusion Tension-free repair of inguinal hernia is superior to traditional hernia repair in the elderly patients.