55 mm or course of AF over 2 years [54.5%(24/44) and 68.7%(46/67),?2=29.265,P=0.000 and ?2=13.814,P=0.000].Conclusion RFA Maze Ⅲ procedure during open-heart surgery is safe and effective for patients with AF.

Objective To evaluate the effects of smecta in prolonged hemorrhagic shock.Methods The modified Wigger's method was used to induce hemorrhagic shock in anesthetized rabbits.Twenty-nine rabbits were randomly divided into hemorrhagic shock group(n=14),smecta group(n=15),with smecta solution being administered via a gavage tube before shock.The plasma levels of endotoxin,tumor necrosis factor ?(TNF?),interleukin-6(IL-6) and nitric oxide(NO) were detected at pre-shock and post-shock,immediately after resuscitation and 2h after resuscitation.Blood culture was done at pre-shock,immediately after resuscitation,2h after resuscitation.The survival rates of 24h and 48h were observed.Results The plasma levels of endotoxin,TNF?,IL-6 and NO markedly increased after shock,and were maintained at high level in shock group (P

Objective To evaluate the effects of aminoguandine(AG) used as a selective inhibitor of the inducible isoform of nitric oxide synthase(iNOS) and L NAME used as a non selective inhibitor of nitric oxide synthase(NOS) on severe hemorrhagic shock Methods Forty rabbits were bled to mean arterial pressure of 4 4 66 kPa via femoral artery Hypotention was maintained for 120 min, the shed blood was then returned, followed by an infusion with Ringer′s solutions Animals were randomly divided into three groups: hemorrhagic shock group (n=14), AG group (AG 20mg/kg was infused intravenously ,n=14), L NAME group (L NAME 30mg/kg was infused intravenously with ,n=12) Plasma levels of endotoxin, tumor necrosis factor(TNF?) and nitric oxide (NO) were determined before and after shock, immediately after resuscitation and 0 5h, 2h, 4h after resuscitation The 24h and 48h survival rates were recorded Lung, intestine, liver and kidney tissues were obtained 48 h after shock for microscopic examination Results The plasma endotoxin, TNF? and NO levels markedly increased and were kept at high levels after shock Lower plasma levels of endotoxin TNF? and NO, less tissue damages and high survival rates were observed in AG group as compared with those in L NAME group and shock group Conclusions The endotoxin,TNF? and NO play an important role in the development of irreversible shock AG is beneficial in the treatment of hemorrhagic shock, while L NAME does not improve the outcome of shock

Objective The preservation of all subvalvular apparatus for chronic mitral regurgitation has been reported in many studies. In this paper we analyzed the effects of complete chordal preservation for mitral stenosis versus mitral regurgitation on postoperative recovery.Methods Thirty-nine patients undergoing mitral valve replacement(MVR) with preservation of all subvalvular apparatus were divided into two groups, mitral stenosis (MS) group(n=23) and mitral incompetence (MI) group(n=16), according to the preoperative diagnosis. Echocardiography was performed preoperatively and at the time of discharge to determined left ventricular end diastole dimension (LVEDD),ejection fraction(EF) and the hemodynamics of the prosthesis.Results The LVEDD and EF did not change in MS group, declined in MI group postoperatively. No hemodynamic disorder of the prosthesis was detected in either group.Conclusions The valve replacement with preservation of all subvalvular apparatus could be used in both the mitral stenosis and mitral regurgitation.The early-term effects of two groups are similar,and the long-term effects are still to be observed.

Objective To analyze the feasibility and superiority of off-pump coronary artery bypass grafting(OPCAB) in patients with left main coronary lesions.Methods A retrospective study was carried out to review our experience on 392 cases with left main coronary lesions,who underwent CABG in our hospital.Among the cases,279 patients(71.2%) underwent OPCAB and 113 cases received CCABG.The early postoperative mortality and complications of the two groups were compared.Results The number of bypass grafts was(4.17?0.86) in Group OPCAB and(4.24?0.94) in Group CCABG,showing no significant difference between them(t=-0.710,P=0.478).No significant difference was detected in peri-and post-operative morbidity between the two groups [atrial fibrillation: 31(11.1%) vs 8(7.1%),?2=1.459,P=0.227;perioperative myocardial infarction: 7(2.5%) vs 3(2.7%),?2=0.000,P=1.000;renal inefficiency: 9(3.2%) vs 4(3.5%),?2=0.000,P=1.000;pulmonary complications: 15(5.4%) vs 6(5.3%),?2=0.000,P=1.000].The early postoperative mortality of Group OPCAB was significantly lower than that in Group CCABG[2(0.7%) vs 5(4.4%),?2=4.368,P=0.037].The time of intubation[20(8-48) h vs 51(14-130) h,Z=-2.823,P= 0.005],ICU-stay [51(38-141) h vs 92(42-352) h,Z=-2.618,P=0.009],volume of transfusion [500(200-1200) ml vs 800(400-2100) ml,Z=-2.411,P= 0.016],re-open [5(1.8%) vs 10(8.8%),?2=9.052,P=0.003] and complication of CNS [3(1.1%) vs 9(8.0%),?2=10.647,P=0.001] of Group OPCAB were significantly less than that of Group CCABG.Conclusions It is feasible,safe and effective to perform OPCAB in patients with left main coronary lesions.

Objective To study the risk factors associated with death of patients suffered from acute exacerbation of interstitial pneumonia (AE-IP) with very high mortality and very difficult to handle so as to find the most suitable treatment strategy for these patients.Methods The data of 26 patients with AE-IP admitted to Emergency Intensive Care Unit in Peking Union Medical College Hospital from September 2010 to September 2013 were restrospectively analyzed.Comparison of general condition of patients,treatment strategy and response to non-invasive ventilation of patients was made between survival group and death group.Results There was no significant difference in general condition of patients between death group and survival group.But compared with idiopathic pulmonary fibrosis (IPF),connective tissue disease-related interstitial pneumonia had a tendency to accounting for higher proportion in the survival group.The rats of endotracheal intubation and invasive ventilation were significantly increased in death group (14％ vs.84％,P ＜ 0.05).There was significant improvement in PaO2/FiO2 after non-invasive ventilation for 2 hours in the survival group (176 ± i10 vs.218 ±64,P ＜0.05) while the death group had no significant improvement.Conclusions In patients with AE-IP,connective tissue disease associated interstitial pneumonia might have better outcome than IPF.AE-IP patients have a very high mortality rate once patients intubated,thus the decision of intubation in such patients needs to be very cautious.The patients with negligible improvement in PaO2/FiO2 after non-invasive ventilation for 2 hours may have a poor prognosis.

Objective Respiratory variations in the pulse oximetry plethysmographic waveform amplitude (△POP) have been popularly studied as a dynamic indicators for fluid responsiveness assessment.The authors hypothesized that △POP can indicate fluid responsiveness in septic shock patient in emergency department.Methods A prospective study of 28 patients with septic shock was carried out in Emergency Room and Emergency Intensive Care Unit from 1 October,2010 to 30 September,2011.Hemodynamic data including cardiac index,stroke volume Variation (SVV) and △POP were recorded before and after volume expansion treatment.Fluid responsiveness was defined as an increase in cardiac index of 15％ or greater.Results Changes in △POP after volume expansion were greater in responders than that in non-responders (P ＜ 0.01).There was a significant relation between △POP and SVV before volume expansion (r =0.900,P ＜ 0.0001).Conclusions △POPcan indicate fluid responsiveness non-invasively in septic shock patient in emergency department.This marker has potential clinical application with high sensitivity and reliability.

Objective To explore the medication closed-loop management of huangshi central hospital based on electronic medical records.Methods Diversified pharmaceutical information platform was constructed.The full coverage of all aspects of medication information,such as ordering/prescribing,transcribing,distributing,preparing,dispensing,administering,documenting,and monitoring was realized.Results The medication management and use had no information gap,and bias could be controlled to form a closed-loop management.Conclusion Application of the new information technology in the field of pharmaceutical care can improve work efficiency,reduce medication errors,broaden the vision of clinical pharmacists and scope of work,and improve the overall level of pharmaceutical care.

Objective To observe the expression of the small heat shock protein (HSP27) in the optic chiasma (OC), optic tract (OT), dorsal lateral geniculate body(LG) and superior colliculus (SC) of the adult golden hamster after intraorbital transection of the left optic nerve (ON). Methods The experimental animals were left to survive for l, 2, 3, 4, 5, 6, 8 weeks following ON transection. The animals were perfused with formol-saline and brains were excised, sectioned and stained with the immunohistochemistry. The sections were observed under the light microscope, the optical density (A) was measured and the data were analysed statistically. Results Immunohistochemical results indicated that the HSP27-expressions were not different between the right and left side of the OC, OT, LG and SC in normal or sham-operation controls. However, following transection of the left ON, HSP27 immunohistochemical stainings in the right site of OC, OT,LG and SC were increased, comparing with the left side. The maximum difference of HSP27 immunostaining between the right and left side appeared in the lst week following left ON axotomy. The sharply decrease of the A difference occurred at the 2nd week after axotomy with insignificant changes in the subsequent several weeks. And the significant A difference was observed in most time except 6th week. Most of HSP27-positive cells had morphological appearances similar to astrocytes with smaller cell body and numerous processes. Conclusion After the transection of monolateral ON, HSP27 expressions in the contralateral optic pathway of brain increased and persisted up to 8 weeks. This result suggested that the increase of HSP27 expression had something to do with the injury of the optic pathway, but the mechanism and biological significance of the increase in HSP27 expression level required to be studied further.;

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.