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.

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: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.

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 explore the feasibility and superiority of the simple controllable aerocyst pressurization wrapped-up bondage for battlefield first aid in the future high tech local war. Methods The disposable infusion bag is wrapped up in the bottom of the sling in stead of partial surgical dressing. Sphygmomanometer, pressure gauge and heparin hat are connected. Inflate and pressurize the sphygmomanometer and keep the pressure between 3kPa and 5kPa. Results The structure of this bandage is simple and can be operated easily. The pressure is controlled nimblely and conveniently. Except for the accurate effect, it is versatile and inexpensive. In addition, it can be employed in the bone fracture.

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.

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.

Objective: Testicular mixed germ cell tumor is mixed with embryonal carcinoma, choriocarcinoma, yolk sac tumor, teratoma, seminoma and other two or more components of the testicular tumor, the clinical is relatively rare and high degree of malignancy, this article will summarize its clinical features and optimize its treatment.Methods: A retrospective analysis of the clinical data of 22 patients with testicular tumor mixed germ cell in Peking University Third Hospital from May 1994 to November 2016 was conducted using a combination of statistical analysis and discussion of the relevant literature.Results: The mean age of the 22 patients was (30.8±10.4) years and the rate of cryptorchidism was 13.6%.The maximum diameter of the tumor was (5.1±2.7) cm.The pathological results suggested that 12 cases (54.5%) contained two different germ cell tumor components, 7 cases (31.8%) contained 3 different tumor components, 2 cases (9.2%) contained 4 different tumor components, and 1 case (4.5%) contained 5 different tumor components.Tumor constituent analysis included yolk sac tumors(16 cases, 72.7%), mature teratoma (7 cases, 31.8%), immature teratoma (5 cases, 22.7%), embryonal carcinoma (17 cases, 77.3%) , choriocarcinoma (4 cases, 18.1%) and seminoma (6 cases, 27.3%).American Joint Committee of Cancer tumor staging indicated 19 cases of stage Ⅰ a tumor, 2 cases of stage Ⅱa tumor and 1 case of stage Ⅲa tumor.The mean values of human chorionic gonadotropin, alpha-fetoprotein and lactate dehydrogenase were 414.50 MIU/mL, 242.95 μg/L, 196.95 U/L (preoperative) and 17.20 MIU /mL, 90.20 μg/L, 183.70 U/L (postoperative within a year), and the comparison of the P values between the preoperative and the postoperative within a year were 0.079, 0.043 and 0.624.Fourteen patients underwent retroperitoneal lymph nodes dissection.Most patients lived with long-term survival (94.4%) after operation.Conclusion: Comprehensive treatment of radical orchiectomy with retroperitoneal lymphadenectomy combined with necessary radiotherapy or chemotherapy might help to control the tumor and achieve long-term survival for most patients with testicular mixed germ cell tumor.

Objective To investigate the effects of aerobic exercise on tau phosphorylation and PI3K/ Akt pathway in the hippocampus of obese rats,and provide some theoretical basis for physical activity improving obesity-related neurological disorders.Methods Male Sprague-Dawley rats aged 3 weeks were randomly assigned to either a high-fat or a normal diet protocol for 12 weeks.Animals submitted to the high-fat diet were further divided into two groups:a sedentary group (HF-Sed) and an exercise group (HF-Ex).The rats fed the normal diet were also divided into a sedentary group (ND-Sed)and an exercise group (ND-Ex).The rats in the HF-Ex and ND-Ex groups underwent a treadmill training for 8 weeks.Then the hippocampus was isolated at 48h after the last exercise.The protein and phosphorylation levels of tau,glycogen synthase kinase 3β (GSK3β),phosphoinositide 3-kinase (PI3K) and Akt were assayed using Western blotting.Results After 12 weeks of feeding,55％ of rats in the high-fat diet group reached the conditions for the obesity model.After 8 weeks of treadmill exercises,in the HF-Sed group the phosphorylation level of tau was significanlty higher than that in the ND-Sed group,while in the HF-Ex group that was significantly lower than the HF-Sed group.Moreover,in the HF-Sed group the phosphorylation level of GSK3β Ser9 was significantly lower,and the phosphorylation level of GSK3β Tyr216 was significantly higher than the ND-Sed group,indicating the activity of GSK3β was significantly higher than the ND-Sed group.However,after 8 weeks of treadmill exercise,in the HF-Ex group the phosphorylation level of GSK3β Ser9 was signfiicantly higher,and the phosphorylation level of GSK3β Tyr216 was signficanlty lower than the HF-Sed group,indicating significantly lower activity of GSK3β than the HF-Sed group.Then,in the HF-Sed group the protein levels of PI3K p110 and p85 subunits,and the phosphorylation levels of Akt Thr308 and Ser473 were significantly lower than those in the ND-Sed group,indicating inhibited activity of the PI3K/Akt pathway.However,in the HF-Ex group the protein levels of PI3K p110 and p85 subunits and the phosphorylation levels of Akt Thr308 and Ser473 were significanlty higher than those in the HF-Sed group,showing the activity of PI3K/Akt pathway was enhanced.Conclusion Obesity induces tau hyperphosphorylation in the rats hippocampus and long-term aerobic exercises can reduce tau hyperphosphorylation by increasing PI3K/Akt pathway activity and inhibiting GSK3β activity.It has a positive effect on delaying the formation of neurofibrillary tangles and improving obesity-related neurological disorders.