Objective To investigate the influence of dexmedetomidine on hemodynamic,cerebral state index(CSI) and awakening quality in elderly patients after total hip replacement.Methods Sixty cases of elderly patients undergoing total hip replacement surgery who ASA classification Ⅰ-Ⅱ,were divided into observation group and control group by random number table with 30 cases each.After establishing patients with upper limb venous access,the patients in observation group received load 0.4 μ g/ (kg· h) dexmedetomidine given by micro 10 min intravenous infusion pump,and the maintenance dose was 0.3 μ g/ (kg· h),while those in control group with pump equivalent in 0.9％ sodium chloride.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),CSI were recorded into the operating room (T0),beginning of pump drugs (T1),beginning of pump drugs 10 min(T2),beginning of skin incision (T3),beginning of skin incision 30 min (T4),extubation (T5),after extubation 30 min (T6).And recovery time,extubation time and observer's assessment of alterness/sedation (OAMS) score after surgery 30 min were recorded.Results The SBP,DBP,HR in two groups began to decrease at T2 and began to increase at T5,the difference was significant at T2-T5 and T0(P＜ 0.05).And the SBP,DBP,HR in observation group at T5 and T6 were lower than those in control group,the differences were significant (P ＜ 0.05).The CSI in observation group was began to decrease at T2 and began to increase at T5,the difference was significant at T2-T5 and T0 (P ＜ 0.05).And the CSI in observation group at T2-T6 compared with control group in the same period,the difference was statistically significant (70.34 ±4.99 vs.92.76 ±4.63,40.73 ± 3.79 vs.70.49 ± 3.51,40.93 ± 3.67 vs.71.82 ± 3.37,91.92 ± 5.28 vs.76.01 ± 4.90,92.49 ± 5.32 vs.80.53 ± 4.89,P ＜ 0.05).The recovery time and extubation time in observation group were lower than those in control group [(14.22 ± 1.11) min vs.(19.56 ± 1.05) min,(13.82 ± 0.94) min vs.(21.61 ± 0.88) min],and the OAA/S score was higher than that in control group [(4.29 ± 0.27) scores vs.(2.87 ± 0.24) scores],the difference was significant (P＜0.05).Conclusions The dexmedetomidine can reduce the impact on hemodynamics in elderly patients after total hip replacement,and can reduce CSI,deepen the depth of anesthesia,reduce the extubation time and recovery time.It is an ideal method of anesthesia for elderly patients after total hip replacement.

Objective To establish the clinical reference of serum homocysteine in Xi’an region.Methods 310 cases of serum of healthy persons were collected to test the homocysteine concentrations using Enzyme circulation method.Results Health-y adult male homocysteine value was significantly higher than female and its reference range was:men 0~1 6.3 5μmol/L and women 0~12.89μmol/L.Conclusion Have established the healthy crowd in Xi’an region serum HCY reference for the re-gion’s heart cerebrovascular disease treatment and prognosis.

Objective To investigate the correlation between tumor perfusion parameters and tumor volume and Child-Pugh classification in CT of hepatocellular carcinoma (HCC).Methods Fifty-six patients with hepatocellular carcinoma were selected to perform CT perfusion imaging.The parameters of the total tumor perfusion such as hepatic artery perfusion (HAP),portal vein perfusion (PVP)and hepatic perfusion index (HAPI)were calculated according to the degree of hepatic encephalopathy,albumin,bilirubin, clotting time,ascites for liver Child-Pugh classification.The relationship between the tumor or peritumoral perfusion parameters with tumor volume and Child-Pugh classification were analyzed.Results (1)There was no correlation between tumor or peritumoral perfusion with the tumor volume.(2)The difference of HAP,PVP and HAPI between the different Child-Pugh classification groups was statistically significant (P<0.000 1).(3)With the reduction of Child-Pugh classification,the tumor body HAP and HAPI values gradually decreased, while the PVP value increased gradually.Conclusion There is no correlation between the tumor volume of hepatocellular carcinoma with total tumor perfusion parameters.The differences in perfusion measurements between different Child-Pugh classification can intuitively and quantitatively reflect the reserve function of the liver.

Objective:To study the prevalence and clinical characteristics of hepatitis D patients.Methods:A total of 832 144 HBsAg positive persons who were from infectious department of Southwest Hospital Affiliated to Army Military Medical University were screened from January 1, 2010 to December 31, 2020. A total of 13 585 subjects completed relevant Hepatitis Delta virus (HDV) biomarker tests, 157 HDV patients were evaluated. The mean age was 53 ± 13 years, with a range of 22-85 years. The majority of these subjects were male. The prevalence, clinical characteristics, the outcome of 28 days follow-up and the influencing factors of the outcome were analyzed.Results:In recent 10 years, the screening rate related to hepatitis D was only 1.6% (13 585/832 144), and the screening rate was the highest in 2011, up to 4.13% (962/23 289); The positive rate of screening was only 1.17% (157/13 346). In 2012, the positive rate of screening was the highest, up to 3.56% (58/1627). In Southwest Hospital, the source of disease was 66.24% (104/157) in Chongqing, 22.93% (36/157) in Sichuan, 8.28% (13/157) in Guizhou, 1.27% (2/157) in Yunnan, and 0.64% (1/157) in each of Jiangxi and Tibet. Of 157 patients, 29 (18.47%) had non-cirrhotic with chronic low bilirubin hepatitis, 23.57% (37/157) was non-cirrhotic with chronic high bilirubin hepatitis, 28.66% (45/157) had acute-on-chronic liver failure (ACLF), 27.39% (42/157) had compensated cirrhosis or decompensated cirrhosis, and 1.91% (3/157) had primary hepatocellular carcinoma. The incidence of disease progression was 48.89% (22/48) of chronic-on-acute liver failure>33.33%(1/3) of primary hepatocellular carcinoma>25.58%(11/43) of compensated or decompensated cirrhosis>18.92%(7/37) of non-cirrhotic with chronic high bilirubin hepatitis>6.90%(2/29) of non-cirrhotic with chronic low bilirubin hepatitis ( P<0.05). Among them, 7.64%(12/157) had hepatic encephalopathy, and the rate of disease progression was 83.33%(10/12) ( P<0.05); 3.82% (6/157) of them had combined with other hepatophilic viruses including hepatitis C virus (HCV), Epstein-barr virus, (EBV), Cytomegalovirus (CMV) infections. Logistic regression analysis showed that old age, complication with hepatic encephalopathy, hyperbilirubinemia and prolonged coagulation time were independent risk factors affecting the outcome of hepatitis D. Conclusions:In recent 10 years, the screening rate of hepatitis D is low and the positive rate is not high. It should be noted that HDV infection can accelerate the progress of hepatitis and increase the risk of adverse liver outcomes.