Objective To design fast cluster indicators (FCIs) and compare it with the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scoring to judge the value and prognosis of sepsis patients.Methods Based on 33 cases of severe infected patients as samples for this study from September 2013 to July 2014 in Intensive Care Unit (ICU) in the Second People's Hospital of YiYang,and with the Procalcitonin (PCT),lactic acid (LAC),D-Dimer (DD) and base excess (BE) as the indicators,as well as drawing on the APACHE Ⅱ scoring system ideological,as is to design the FCIs to evaluate the prognosis of patients with severe infection.Results After treatment,the survivals were 17 cases,16 patients were died out of 33,and the mortality rate was 48.5％.The sensitivity and specificity of fast cluster indicator that predict patient mortality rates were 75％ and 71％,respectively.The area under the receiver operating characteristic curve (ROC) of FCIs assessing the prognosis of patients with severe infections was 0.895,which was higher than the value 0.721 of APACHE Ⅱ scoring.Conclusions FCIs scoring has a certain significance and guiding role in clinical practice.

Finite element analysis can analyze the stress and strain change of object with complex shape,structure,constitution and load condition,and is widely applied to spinal biomechanical studies due to its controllability,reproducibility and versatility in mechanics tests.The article briefly introduced several finite element analysis software,summarized the mechanical characteristics of vertebral body,intervertebral disc,accessories and the ligament and muscle around the spine,and summarized research achievements of finite element analysis in lumbar fusion,concerning the biomechanics of Cage,its influence on lumbar fusion and related surgery choice,dynamic fusion,artificial intervertebral disc and the biomechanical variation of different fusion style after spinal tumor vertebrectomy.Finite element analysis can help understand the spine biomechanics and provide biomechanical reference for lumbar fusion choice.

Objective To compare the changes of blood coagulation system and the clinical interventional effect of low molecular weight heparin (LMWH) in elderly patients who had received thoracic surgery. Methods Ninety-six thoracic surgery patients (age≥70 years) were divided into control group ( 54 cases ) and experimental group ( 42 cases ) ( postoperative 1-7 days, subcutaneous injection with LMWH ) from September 2007 to December 2009 by random digits table. Observed perioperative changes in prothrombin time (PT),activated partial thromboplastin time (APTT),platelet (Plt),D-dimer (D-D),fibrinogen (Fib), anti- X a activity, and clinical performances. Also observed the influence of diabetes mellitus of surgery coagulation function. Results The preoperative indexes of coagulation function were no significant (P ＞ 0.05 ). In control group PT prolonged, Fib and D-D increased, the differences between preoperative and postoperative each time were significant (P ＜ 0.05 ). Fib and D-D in control group increased than those in experimental group postoperative each time (P ＜ 0.05 ). In experimental group anti- X a activity increased postoperative each time (P ＜ 0.05 ),compared with control group was also significant (P ＜ 0.05 ). Diabetes mellitus had no significant influence on coagulation function. One patient appeared pulmonary thromboembolism in control group,and no one appeared venous thromboembelism and bleeding adverse reactions in experimental group. Conclusion Thoracic surgery in elderly patients have high blood coagulation state, prone to venous thromboembolism, LMWH given early postoperative prophylactic treatment is beneficial to improve the hypercoagulable state and have better security.

Objective To evaluate the efficacy of Shikani laryngoscope-guided nasotracheal intubation in patients undergoing maxillofacial surgery. Methods One hundred ASA Ⅰ or Ⅱ patients with body mass index ＜25 kg/m2 , aged 18-64 yr, undergoing maxillofacial surgery under general anesthesia requiring nasotracheal intubation were included in this study. Fifty patients without anticipated difficult airway in preoperative assessment were randomly divided into 2 groups ( n = 25 each): Macintosh luyngoscope group ( group M ) and Shikani Optical Stylet (SOS) group (group S1 ). The other 50 patients with mouth opening ＜ 3 cm but without difficult ventilation by mask were randomly divided into 2 groups ( n = 25 each): fiberoptic bronchoscope group (group F) and SOS group (group S2 ). Tracheal intubation was performed under the guidance of laryngoscopes after induction of anesthesia, and then the patients were mechanically ventilated. The degree of glottis exposure and epistaxis was evaluated. The rate of successful intubation, rate of successful intubation at first attempt, intubation time and complications were recorded. Results Compared with group M, the rate of successful intubation, rate of successful intubation at first attempt, and degree of glottis exposure were significantly increased, the intubation time was significantly shortened, and the degree of epistaxis was significantly decreased ( P ＜ 0.05), but no significant change was found in the complications in group S1 ( P ＞ 0.05). Compared with group F, the intubation time was significantly shortened ( P ＜ 0.05), but no significant change was found in the rate of successful intubation, rate of successful intubation at first attempt and complications in group S2 ( P ＞ 0.05). Conclusion Shikani laryngoscope can expose glottis better and the rate of successful intubation at first attempt is higher, thus it is more suitable for nasotracheal intubation in patients undergoing maxillofacial surgery.

Objective:To investigate the expressions and their clinical significance of vascular endothelial growth factor (VEGF) and extracellular matrix (ECM) components in non-small cell lung cancer (NSCLC). Methods:Expressions of VEGF and ECM components (fibronectin, FN and collagen Ⅳ, cⅣ) in 50 cases of NSCLC tissues and 20 cases of normal lung tissues were detected by immunohistological analysis. Their relationship with clinical features of NSCLC and the correlation of expression of VEGF and Fn and cⅣ were analyzed.Results:The positive expression rates of VEGF, Fn, and cⅣ were 96%, 78%, and 50% in NSCLC tissues. The expressions of VEGF and Fn were significantly higher than those in normal lung tissues (P<0.05). The expression of Fn and over-expression of VEGF were associated with lymph node metastasis (r=1.00, P<0.001). The survival rate of patients with over-expression of VEGF was greatly lower than that with weak expression of VEGF (P=0.022). The survival rate of Fn-negative patients was markedly higher than that of Fn-positive patients (P=0.046). Conclusion:VEGF and ECM component Fn were highly expressed in NSCLC, which correlated with lymph node metastasis and survival rate. Expression of ECM and VEGF had positive correlations, suggesting that ECM might be one of the anti-angiogenesis targets for tumor therapy.

Objective To survey the knowledge of chronic stable coronary artery disease management among general practitioners (GPs) in Shanghai Pudong New Area.Methods The survey was conducted among 363 GPs with at least 2-year work experiences from community health service centers in Shanghai Pudong New Area from July to September in 2014.A self-designed questionnaire based on the guidelines/consensus of chronic stable coronary artery disease management were used in the survey.The questionnaire consisted of 4 parts:diagnosis,drug therapy,revascularization and treatment of special types.Results Among 363 participants 362 questionnaires were completed.History taking,physical examination and electrocardiogram were applied for diagnosis in all participants,49.2％ (178/362) also used coronary computed tomography angiography,26.5％ (96/362)used exercise testing for assistant examination.More than 95.0％ of participants recognized that smoking,obesity,hyperlipidemia,hypertension,diabetes were risk factors.75.7％ (274/362) of participants used aspirin,91.4％ (331/362) knew the dose of aspirin as 75-150 mg;for aspirin intolerance 14.6％ (53/362)would use clopidogrel alternatively.50.6％ (183/ 362) of participants sometimes used statins;and 39.2％ (142/362) did not use stain because of not knowing the contraindication.Facing increases of alanine aminotransferase or aspartate aminotransferase levels 95.3％ (345/362) of participants would immediately discontinue stain;80.4％ (291/362) discontinued statins as creatine kinase increased.32.0％ (116/362) of participants gave enough drug-free period avoiding nitrates resistance.79.6％ (288/362) seldom used β-blockers and 42.5％ (154/362) failed to use β-blockers because not knowing the contraindication.78.7％ (285/362) knew percutaneous coronary intervention but did not know its indications;83.1％ (301/362)knew coronary artery bypass but did not know its indications.27.6％ (100/362) knew calcium antagonists were first-line drugs for variant angina and 93.6％ (339/362) never heard of microvascular angina.Conclusion The survey shows that GPs from community health service centers in Shanghai Pudong are not well familiar with examination of coronary heart disease and lack of sufficient knowledge of drugs recommended by the guideline,not well understand the indications for revascularization and the diagnosis and treatment of special types of coronary heart disease.

Objective To modify the posterior procedures for severe thoracolumar fractures. Methods Twenty-one patients of thoracolumbar fractures with over 40% of anterior compression were studied. After reduction and fixation with short-segment pedicle instrumentation was performed, the transpedicular vertebroplasty of the fractured vertebrae with injectable self-setting calcium phosphate cement was carried out under fluoroscopic guidance. All patients were checked with X-ray and CT scanning before and after operation. They were followed up for 4-23 months (average 13 months). Results All patients obtained successful surgery without neurological complications or foreign body response. On CT scanning, the fractured vertebrae were well augmented in 13 cases and insufficiently augmented in 4 cases. Slight extrusion of cement into paravertebral tissue occurred in 4 cases without clinical symptoms. All patients were perfectly recovered without notable correction loss or implant failure during the follow-up. Conclusions Reduction and fixation with short-segment pedicle instrumentation followed by vertebroplasty with injectable self-setting calcium phosphate cement is a promising procedure for severe thoracolumbar fractures.

three years survival group,and those who died within 3 yrs had P-gp positive expression(24 cases,53.3%).Comparing of the two groups showed statistical significance(P3 year survival stage group,and the patients who died within three years group,the P27 expression was positive in 26 cases(56.5%)(P

Objective To evaluate the clinical value of vertebral body venography in performance of percutaneous vertebroplasty(PVP). Methods 92 patients with 124 vertebraes underwent PVP. Before injecting the bone cement, venography was performed with injection of nonionic contrast material into vertebral body. 124 vertebraes were classified into four groups according to the results of vebgrophy. Group A: no draining veins displayed; group B: draining veins appeared late; group C: draining veins appeared ahead of time; group D: draining veins appeared ahead of time, then intervention such as adjusting the puncture needle's position or gelatin sponge embolization of vein was performed to delay the appearance of veins. Results 94 of 124 vertebraes displayed draining veins. According to the results of vebgrophy, there're 30 vertebraes in group A, 25 in group B, 30 in group C, 39 in group D. Thirty-seven vertebraes demonstrated cement extravasation, cement entering vein was observed in sixteen vertebraes and two patients among them had pulmonary embolism. Venograms showed all correlative venous extravasation. Bone cement extravasation rate of each groups was 20.0%, 24.0%, 56.7% and 20.5% respectively. Moreover, extravasation rate of group C was higher than any other group. Pain reduction was observed in 88 of 92 patients after 30 days of the operation, the rate of pain relief was 95.7%. Conclusion Vertebral body venography could describe the velocity of venous blood flow within vertebral body and predict the direction of bone cement leaking to veins effectively, which could provid valuable information in takeing some measures to prevent bone cement leaking into veins. Vertebral body venography has very impotant clinical value in improving the safety and preventing complication of PVP.

To assess the roles of glutamate and its ionotropic receptor in processing noxious sensory input from dental pulp,glutamate NMDA receptor subtype antagonist,MK-801 and non-NMDA receptor subtype antagonist,CNQX were administrated separately into left lateral cerebral ventricle prior to exposing pulp cavity of left maxillary first molar tooth.The number of Fos-positive neurons in medulla oblongata was measured and compared with that of the group with simple exposure of dental after same survival time pulp.Fos protein expression was reduced dose-dependently by an administration of MK-801,but CNQX had little effect.The results showed that glutamate may be an excitatory transmitter of noxious dental pulp sensory input to neurons in medulla oblongata.In pain nodel of mechanical exposing dental pulp,NMDA receptor subtype has an important role in this process.