Objective To evaluate application of antihypertensive drugs.Methods We counted up and analyzed the sum of money,using frequency,quantity and dayly therapeutic fees of the antihypertensive drugs by methods of money ranker and DDDs analysis.Results The most often used antihypertensive drugs were the three as follows:calcium channel blocker,?-receptor blocker and angiotensinⅡ receptor antagonist.We earned more money for the three antihypertensive drugs:calcium channel blocker,angiotensinⅡ receptor antagonist and angiotensin converting enzyme inhibitor.Conclusions The using of antihypertensive drugs is rational.And also we should avoid adverse reaction caused by these drugs compatibility use and ensure medicative safety.

BACKGROUND:Studies suggested that blood loss was great during total knee arthroplasty, even blood transfusion was needed. Application of the tourniquet wil destroy the coagulation system, and is not conducive to hemostasis after replacement. Recently, tranexamic acid has been extensively used to reduce blood loss during total knee arthroplasty, because of low price, simple administration pathway, and effective effects on hemostasis. OBJECTIVE:To summarize the application and safety of tranexamic acid in total knee arthroplasty. METHODS:The first author retrieved PubMed and Chinese Journal Ful Text Database for articles from inception to October 2015. The key words were tranexamic acid, total knee arthroplasty, hemorrhage. More than 200 articles were retrieved, and finaly 50 articles met the inclusion criteria. RESULTS AND CONCLUSION:Tranexamic acid is a fibrinolytic inhibitor, can reversibly block the binding of plasminogen to fibrin, effectively inhibit fibrinolysis, and reduce hemorrhage after total knee arthroplasty. Nevertheless, there were significant differences in the use, dose and effect of tranexamic acid on hemostasis among different studies. Tranexamic acid was an effective drug for hemostasis during total knee arthroplasty. During total knee arthroplasty, tranexamic acid had been used to reduce dominant blood loss and hidden blood loss after arthroplasty, and could not increase the risk for venous thrombosis of lower limb. Currently, the timing of use, dosage, route of administration, and possible complications of tranexamic acid remain controversial.

Objective To investigate the CT imaging features of urinary tract ceftriaxone-associated pseudolithiasis.Methods The CT imaging data of three patients with ceftriaxone-associated pseudolithiasis were collected from August,2008 to April,2012.Their data combined with related literatures were used to review CT imaging features of urinary tract pseudolithiasis.Those three patients,including 2 males and 1 female,were 9,21 and 55 years old,respectively.Ceftriaxone sodium was administrated to one patient due to appendicitis and the other two patients due to urinary tract infection.After ceftriaxone treatment,1 case began to have backache and abdominal pain on day 13,1 case presented backache with floc in the urine on day 2 and progressed to anuria,and the other one had cotton-like material in the urine on day 5.Urinary tract high density shadows were found in all patients by CT scan.The patient with anuria was treated with ureteroscopic lithotripsy and percutaneous nephrolithotomy.The other 2 cases were arranged to be followed up with CT scan.In those cases,the CT showed that the high density shadow in one patient disappeared 16 days after drug discontinuation.The high density shadow was significantly reduced 12 days after ceftriaxone withdrawal in the other one.However,no follow-up was performed afterwards.Results All the urinary tract ceftriaxone-associated pseudolithiasis presented the high density shadows on CT,with CT value 47-667 HU.The density of CT results is homogenic,except one ureteral stone.The pseudolithiasis,existed in kidney,ureter and bladder simultaneously,were found in two patients.And the other patient was found that the pseudolithiasis existed in both kidney and bladder.Two cases were accompanied with hydroureter and hydronephrosis and the other case were accompanied with cholecystolithiasis.The multiple renal pseudolithiasis was noticed in 2 cases,which exhibited the nodular shape.And one patient with hydronephrosis presented both sand-like and nodular stones.Ureteral pseudolithiasis was found in 1 case with 4 stones and the other one with 2 stones.In those pseudolithiasis,5 appeared column morphology and one showed nodular shape.The single nodular stone in bladder was found in one case.And the multiple bladder stones were found in 2 cases.Conclusions The CT imaging characters of urinary tract ceftriaxone-associated pseudolithiasis are high homogenic density shadows in multiple parts of bilateral urinary tracts.The ceftriaxone-associated pseudolithiasis is column shape in ureter and sand-like or nodular shape in kidney and bladder.

BACKGROUND: There are more measurement data about knee joint at home and abroad, but few data about the northern China, especially Inner Mongolia region. Whether the posterior slope angle of tibial plateau in local area differs from that of Chinese or foreigners is rarely reported.OBJECTIVE: To measure the posterior slope angle of the medial tibial plateau in healthy Mongolia population, and to compare the differences of different measurement methods, so as to understand the anatomical characters of tibial plateau in Inner Mongolia region.METHODS: Sixty Mongolian volunteers were recruited, the 20 cm upper and under the knee joint were scanned bilaterally by GE64 row spiral CT, and the three-dimensional model of the knee was established on Mimics16.0 software, followed by processed through fairing, filling, separation and cutting. Afterwards, the angel between anterior cortical bone extension line of upper tibia (method A), tibia anatomical axis (method B), line perpendicular to the posterior cortical bone extension line of upper tibia (method C) and upper edge line of the tibial plateau was measured,respectively. The posterior slope angle of the medial tibial plateau (90°-measured angle) was obtained and compared.RESULTS AND CONCLUSION: (1) The posterior slope angle of the medial tibial plateau measured by methods A, B and C was (11.16±3.39)°, (8.60±3.29)° and (5.30±4.40)°, respectively, and the former two were similar with those reported by Wang Ye-hua and Luo Ji-wei (P > 0.05). (2) There were significant differences in the posterior slope angle of the left and right medial tibial plateau among methods (P < 0.05), but there was no significant difference between left and right sides (P > 0.05). (3) There was no significant difference in the posterior slope angle of the left and right medial tibial plateau between genders (P > 0.05). (4) These results indicate that the Mongolian population show smaller posterior slope angle of the tibial plateau, but the angle exhibits great individual difference, thereafter, an individualize scheme should be developed before osteotomy.

Objective:To describe a feasible surgical technique for patients with renal cell carcinoma associated with a supradiaphragmatic tumor thrombus that avoids cardiopulmonary bypass procedure. Methods:We retrospectively analyzed 2 cases with right kidney tumor and tumor thrombus above the dia-phragm treated in April and August,2015.The two patients were both female,aged 73 and 67 years. The tumor sizes of right kidneys were 7.0 cm ×6.3 cm ×5.7 cm and 8.7 cm ×7.0 cm ×5.2 cm,and the tumor thrombuses were 1.3 cm and 1.8 cm above the diaphragm.The second patient had synchro-nous metastasis in right adrenal gland ,and the tumor thrombus arose from the adrenal vein but not the renal vein.Intraoperative transesophageal echocardiography (TEE)was used to assess real-time mobility of the thrombus.A modified chevron incision was used,the right kidney was mobilized laterally and pos-teriorly,and the renal artery was identified,ligated,and divided.The infradiaphragmatic inferior vena cava (IVC)was exposed and isolated by mobilizing the liver off the diaphragm or to the left (piggyback liver mobilization,case 2).The central diaphragm tendon was dissected or incised in the midline until the supradiaphragmatic intrapericardial IVC was identified and gently pulled beneath the diaphragm and into the abdomen.The tumor thrombus was then “milked”downward out of the intrapericardial IVC un-der the guidance of TEE.The distal and proximal IVC to the tumor thrombus,porta hepatis,and left re-nal vein were clamped.Tumor thrombus was removed from the IVC.The IVC was sutured and vascular clamps were placed below the major hepatic veins.Pringle’s maneuver was then released and hepatic blood drainage was permitted during closure of the remaining IVC.Related literature was reviewed.Re-sults:Complete resection was successful through the transabdominal approach without CBP in both pa-tients.Estimated blood loss was 1 500 mL and 2 000 mL,and 1 200 mL and 800 mL of blood were trans-fused.The postoperative courses were uneventful.Both patients subsequently underwent tyrosine-kinase inhibitor therapy.Both patients were alive without tumor recurrence or new metastasis during the follow-up of 6 months and 9 months.Conclusion:In selected cases,renal cell carcinoma extending into the IVC above the diaphragm can be resected without sternotomy,CBP or DHCA.

Objective To investigate the influence of follow-up treatment compliance on prognosis after gastroesophageal varices treated under endoscopy.Methods Up to 416 liver cirrhosis patients after gastroesophageal varices treated under endoscopy were follow-up and divided into compliance group and control group according to whether the patients had follow-up treatment compliance condition.The factors caused the difference of follow-up treatment compliance were analyzed.The differences in the follow-up indexes such as rebleeding,mortality,rehospitalization were compared between the two groups.The differences in indexes between two groups were stratifiedly analyzed according to liver function Child-Pugh classification.Chi-square four data table test was for two independent samples comparison.Results The differences of education level,income and the medical condition of residential area determined the difference of follow-up compliance.After gastroesophageal varices patients treated under endoscopy,the total rebleeding rate was 35.1 ％ (146/416) and and the mortality rate was 9.4％ (39/416).The rebleeding rate and mortality rate of the compliance group were significantly lower than those of control group (26.1％ (61/234) vs 46.7％(85/182),x2=19.137,P＜0.01; 6.4％(15/234) vs 13.2％(24/182),x2=5.533,P=0.019).Among the 273 Child-Pugh A level patients,the detection rate of liver cancer (3.7％,10/273),liver transplantation rate (3.7％,10/273),splenectomy plus portal azygous disconnection rate (6.6％,18/ 273) of compliance group were higher than those of control group (x2 =4.086,P =0.043; x2 =4.086,P=0.043; x2 =5.515,P=0.019).Among the 102 Child-Pugh B level patients,there were statistical differences between compliance group and control group in rebleeding rate (x2 =21.297,P＜0.01),motality (x2=3.525,P=0.042),ascites (x2=4.451,P=0.035),life quality (x2 =10.454,P=0.001) and liver function (x2 =8.197,P=0.004).However,there were no statistical differences in all indexes between the two groups of Child-Pugh C level patients (all P＞0.05).Conclusion To improve the follow-up treatment compliance remarkably,decreased the rebleeding rate and mortality,contributed to early detection of liver cancer and early liver transplatation,thus the prognosis was improved consequently.

Background and purpose:Cancer is a common disease. Multidisciplinary approach is the best model for cancer treatment. Cancer staging is the basis for diagnosis, treatments and prediction of prognosis.The survey is to give an overview of the current application of cancer multidisciplinary approach and UICC or other international cancer staging in mainland China. We made inquiries to our Chinese oncologists’ experience of using these staging and share their comments and recommendations. For those cancers common in China, Chinese oncologists and academic societies should provide more information of staging, therapies, outcome, prognostic predictors of prognosis, etc. to make international stage systems, like UICC or AJCC, a more appropriate, accurate and acceptable guide to individual patients’ staging and treatment, to predict outcome and to facilitate clinical trials better. Methods: This survey was done from 2012 to 2013 by questionnaires. The questions were answered for 10 major cancers in China (liver cancer, esophageal cancer, nasopharyngeal carcinoma, lung carcinoma, breast cancer, gastric cancer, colorectal cancer, gynecologic cancer, prostate cancer and lymphoma). Thirty-three questionnaires have been answered by national wide hospitals including provincial cancer hospitals, district cancer hospitals and departments of oncology in general hospitals. We also site visited 7 grade B hospitals. Results:Multidisciplinary approach is not widely used in the hospitals. UICC or AJCC stages have been widely used for 10 cancers, but for cancers that were uncommon in the West;while common in China (nasopharyngeal carcinoma, liver cancer) the staging proposed by Chinese society have also been used to replace UICC/AJCC. Conclusion:We suggest a wild implementation of multidisciplinary approach. For those cancers common in China Chinese oncologists and academic societies should provide more information of staging, therapies, outcome, prognostic predictors of prognosis etc. to make international stage systems, like UICC or AJCC, a more appropriate, accurate and acceptable guide to individual patients’ staging and treatments, to predict outcome and to facilitate clinical trials better.

AIM:To investigate the effect of N-[N-(3,5-difluorophenacetyl)-L-alanyl]-S-phenylglycine t-butyl ester (DAPT) on the Notch signaling pathway in a model of oxidized low-density lipoprotein (ox-LDL)-induced human umbilical vein endothelial cell (HUVEC) damage.METHODS:HUVECs were divided into control group, ox-LDL group, DAPT group and ox-LDL+DAPT group.The morphological changes of the HUVECs with different treatments were observed under light microscope.The viability of the HUVECs was measured by CCK-8 assay.The protein expression levels of Notch1, Notch4 and Jagged1 were determined by Western blot.RESULTS:ox-LDL induced great damage to the HUVECs, evidenced by increased cell death and debris in the culture.However, the cell damage was abolished by adding DAPT into the culture.The viability of the HUVECs was increased by co-treatment with DAPT and ox-LDL.ox-LDL treatment significantly decreased the protein expression levels of Notch1 and Jagged1, and elevated Notch4.However, these changes were totally reversed by DAPT.None of these proteins showed significant change in the HUVECs co-treated with DAPT and ox-LDL as compared with control group.CONCLUSION:ox-LDL is able to induce HUVEC damage in vitro.DAPT attenuates ox-LDL-induced damage in the HUVECs by regulating the Notch signaling pathway.

Objective To explore the feasibility and superiority of the simplified partial pressurized tourniquet used in bleeding or injured limbs in battlefield.Methods The tourniquet was composed of the disposable infusion bag,bulb for blood pressure apparatus,pressure gauge and heparin cap.The disposable infusion bag wrapped around the bottom of the cravat took the places of the balloon and the harness.The pressure on the upper and lower limbs were 180mmHg and 200mmHg respectively.Results The low-cost tourniquet,with easily adjustable pressure,was easy to operate and carry.It was efficient in hemostasis and had a low rate for complications.Conclusion The tourniquet can be applied to self and buddy aid,and thus the incidence of shock can be decreased.

Objective To observe the effect of 8-week climbing ladder exercise with load on the expression of proliferator-activated receptor gamma coactivator 1-alpha (PGC1α)/ fibronectin type Ⅲ domain containing 5 (FNDC5)/ myostatin (MSTN)in soleus and extensor digitorum longus muscle and the serum concentration of irisin in Sprague-Dawley (SD)rats.Methods Twenty SD rats were randomly divided into a control (Con,n=10)group and a climbing ladder (Lad,n=10)group.The Lad group took an 8-week and once-every-3-day program of resistance exercise using an improved model of climbing ladder with load.Then the soleus and extensor digitorum longus muscles were isolated at 48 h after exercise.The PGC1α/FNDC5/MSTN mRNA and protein expression in the skeleton muscle were detected using quantitative PCR and Western blotting respectively.The serum concentration of irisin was measured using enzyme-linked immunosorbent assay.Results Compared with Con group,the expression of PGC1α in the soleus muscle reduced significantly (P＜0.05),that of FNDC5 reduced but without significance and that of MSTN increased significantly (P＜0.05)in Lad group.However,the expression of PGC1α in the extensor digitorum longus muscle increased significantly (P＜0.05),that of FNDC5 increased but without significance and that of MSTN decreased significantly (P＜0.05)in Lad group compared with Con group.There were no significant differences in the serum concentration of irisin between the two groups.Conclusion Eight-week climbing ladder exercise with load on rats induces differential expression of PGC1α/FNDC5/MSTN in soleus and extensor digitorum longus muscle,but doesn't influence the serum concentration of irisin.It is suggested that there may be a complex mechanism of balancing and antagonism in the body after long-term resistance exercises.