Objective To investigate and analyze the efficacy of intravenous levosimendan in the treatment of acute cardiac failure after cardiac surgery. Methods The study of the 80 cases of acute heart failure in patients undergoing cardiac surgery after treatment in March 2014 to March 2017, the patients were monitored in the treatment before and after treatment of 24 h heart rate, left ventricular ejection fraction, mean arterial pressure and central venous pressure and other related indicators. Results Of all patients, 58 survived after treatment, and 22 died during or after treatment. Compared with before treatment, after treatment of 24 h in left ventricular ejection fraction in patients, mean arterial pressure, central venous and changes in heart rate were significantly improved, data between the two groups had significant difference compared with statistical significance(P<0.05). In 8 patients, transient blood pressure reduction occurred during treatment, but symptoms disappeared after taking appropriate measures, and other patients had no more severe adverse reactions. Conclusion According to the method of intravenous levosimendan in treatment of acute heart failure in patients undergoing cardiac surgery after treatment can make the patient's cardiac function improved, has a significant effect on the prognosis of patients, should have a relatively high value.

Psoriasis is a kind of immune-mediated chronic inflammatory disease, characterized with skin and joints. This paper reviewed the effect of traditional Chinese medicine on thepsoriasis related cytokines, such as interleukin, interferong, tumor necrosis factorα, colony stimulating factor, chemokines and transforming factor, in order to provide theoretical reference for TCM treatment of psoriasis.

OBJECTIVE:To explore the effect of propofol target-controlled infusion on extubation time in patients with ENT surgery under Narcotrend classification guidance. METHODS:52 patients with endotracheal intubation intravenous anesthesia and minimally invasive ENT surgery received target-controlled infusion for anesthesia induction and anesthesia. NI value, plasma concentration of propofol(cm),mean arterial pressure(MAP),pulse oxygen saturation(SpO2)before anesthesia and different time points in recovery period,the correlation of NI with propofol cm of all patients were recorded,and NI with propofol cm and time when extubation was omalysed. RESULTS:There were no significant differences in SpO2 before anesthesia and different time points in recovery period(P>0.05);MAP was significantly higher than before anesthesia at T3,MAP was significantly lower than before anesthesia at T0-T1,propofol cm was T0>T1>T2>T3>T4>T5,NI was significantly lower than before anesthesia at T0-T3, and T00.05). NI when extubation was(86.17±5.29),propofol cm was(0.96±0.31)μg/ml,and average extubation time was (8.26 ± 2.93) min. When extubation,NI showed negative correlation with propofol cm(r=-0.812);and decreased with the prolong of extubation time (r=-0.792);the predictive rates of NI and propofol cm's prediction awareness change in recovery period were 0.93 and 0.86. There were no obvious adverse reactions during treatment. CONCLUSIONS:Propofol target-controlled infusion under Narcotrend classification guidance can accurately predict the awareness change from no response to stimuli to shouting and opening eyes,has a high reference value on extubation time.

OBJECTIVE To investigate the patterns of catheter related infection in critically ill patients after cardiac surgery with prolonged central venous catheters. METHODS The materials of culture of catheter tip and subcutaneous segments in 166 critically ill patients after cardiac surgery with prolonged central venous catheters were reviewed. RESULTS The positive pathogenic bacteria ratio of catheter tip segments was 41.0% and the positive ratio of catheter subcutaneous segments was 47.0%.Catheterization longer than 18 days,body temperature higher than 38.5 ℃ and insertion sites of femoral veins were the variables associated with significantly increased risk of catheter related infection. CONCLUSIONS The positive pathogenic bacteria ratio of central venous catheters in critically ill patients after cardiac surgery with prolonged central venous catheters is high,more attention must be paid to catheter related infection,and efficacious interventions must be laid down.

The evaluation system of PBL teaching was constructed to develop PBL teaching in combination with the characteristics of medical courses. It covered students evaluation system, teacher's evaluation, and teaching pattern system in all aspects of teaching. The present study was carried out through repeated verification in many clinical medicine curriculum and many grades of students, and standardized assessment model, a more mature evaluation system, has been fully applied. All the indices of the evaluation system were comprehensive in contents, scientific, objective, manipulated easily and with good results, which is worth promoting the application of PBL teaching in the future.

Objective To investigate whether mixed venous-arterial carbon dioxide difference (Pv-aCO2) combined with passive leg raising (PLR) could better guide volume management for patients post off-pump coronary artery bypass grafting (OPCABG).Methods Eighty patients experienced OPCABG, and admitted to Tianjin Chest Hospital from June 1st to October 1st in 2016 were enrolled. They were randomly divided into two groups: observation group given Pv-aCO2 combined with PLR directed therapy and control group given central venous pressure (CVP) directed therapy, 40 cases in each group. The difference in body temperature (T), heart rate (HR), mean arterial pressure (MAP), CVP, oxygenation index (PaO2/FiO2), mixed venous oxygen saturation (SvO2), Pv-aCO2, blood lactate (Lac), fluid intake, scores of the vasoactive agents at 6 hours post-operation, sequential organ failure assessment (SOFA) of 24 hours, mechanical ventilation time, the length of intensive care unit (ICU) stay, and hospitalization time were compared. The correlation between Pv-aCO2 and cardiac index (CI), Pv-aCO2 and Lac were analyzed by Spearman analysis in observation group.Results The T, HR, MAP, CVP, PaO2/FiO2, SvO2 and Lac at 6 hours post-operation were higher than those at admission in two groups, and Pv-aCO2 were significantly decreased. The SvO2 and fluid intake in observation group were higher than those in control group [SvO2: 0.671±0.068 vs. 0.634±0.052, fluid intake (mL): 454±151 vs. 304±106, bothP < 0.05], Pv-aCO2, Lac and scores of the vasoactive agents were lower than those in control group [Pv-aCO2 (mmHg, 1 mmHg = 0.133 kPa): 6.1±1.8 vs. 7.0±1.8, Lac (mmol/L): 1.7±0.5 vs. 2.8±0.6, scores of the vasoactive agents: 3.18±1.01 vs. 4.48±1.50, allP < 0.05], mechanical ventilation time and the length of ICU stay were less than those in the control group (hours: 16.52±6.41 vs. 21.96±9.00, 45.51±9.36 vs. 51.76±13.66, bothP< 0.05). There was no significant difference in SOFA, hospitalization time between the two groups. There was negative correlation with Pv-aCO2 and CI (r = -0.752,P < 0.01), and no correlation with Pv-aCO2 and Lac (r = -0.154,P = 0.171).Conclusion Pv-aCO2 combined with PLR can better guide volume management in the patients post OPCABG, reduce the usage of vasoactive agents and decrease the mechanical ventilation time and the length of ICU stay.

Objective Describes the use of homemade simple bedside bracket of children supracondylar fracture closed reduction and percutaneous pin fixed surgical methods and clinical effects.Methods 16 cases of children supracondylar fractures Gartland type Ⅱ cases,15 cases Gartland type Ⅲ,13 males and 3 females,with an average age of 6 years old,all patients used our hospital homemade simple bedside shelf assisted closed reduction,percutaneous pin fixation,and fixed with plaster immobilization.Results 16 patients were followed-up,in addition to the two cases of pin tract infection,fracture all were healed smoothly.Without iatrogenic nerve injury and internal fixation loosening,and also no volkmann contracture,and myositis ossificans etc complications.The average fracture healing time for three weeks,no bone delayed union or nonunion occurred.According to Flynn clinical function evaluation,there were excellent in 7 cases,good in 9 cases.Conclusion Useing homemade simple bedside shelf to children supracondylar fractures closed reduction and percutaneous Kirschner wire fixed can ensure the efficacy,and also simplify the surgical procedure,reduce radiation intake,which is the worthy of clinical practice.

Objective To investigate the outcome of free posterolateral leg perforator flap in the reconstruction of soft tissue defects of oral and maxillofacial area.Methods From February,2014 to August,2016,16 patients were performed defect reconstruction following oral cancer ablation with free posterolateral leg perforator flap including 3 cases of sequamous cell carcinoma of the tongue,6 cases of carcinoma of the buccal mucosa,7 cases of sequamouse cell carcinoma of the floor of mouth.The flap ranged from 5.0 cm×3.0 cm to 13.0 cm ×9.0 cm in size,and were adjected to the soft tissue defects of oral and maxillofacial area.The outcome of reconstruction was evaluated by considering the facial appearance,the swallowing and the speach function,the ranges of mouth opening and patient prognosis.Results All 15 transplanted flaps survived well and only 1 survived after disposing in time,because of vascular crisis.The donor sites were closed directly without donor-site morbidity.All patients were satisfactory with their facial appearance,the ranges of mouth opening and swallowing and speech function.Conclusion The free posterolateral leg perforator was an ideal free tissue for repairing functionally oral and maxillofacial defects,sinceit including some beneficial characteristic such as constant blood vessel,flexible and divese design,abundant and position-latent donor site tissues,small operation loss,flexible preparation and loss of major vascular nerves.

Objective To analyze the correlation of carotid artery stenosis(CAS)with postoperative cognitive dysfunc?tion(POCD)in patients who underwent off-pump coronary artery bypass grafting(OPCABG). Methods Between March 2014 and October 2014, a total of 157 patients who underwent OPCABG in our hospital were enrolled and divided into POCD group and non-POCD group according to their performance respondent to MMSE questionnaire survey conducted 5 days before operation. LOTCA questionnaire survey was conducted at the first day and 7th days pre-and post-operation re?spectively in order to investigate the influence of CAS on POCD in patients. Results The incidence of POCD was 30.6%(48 out of 157). Advanced age, diabetes,cultural level,carotid artery stenosis, Hb level after operation, score of LOTCA question?naire survey conducted before surgery,time of respirator and the time spend in ICU were significant predictive factors for POCD. However, multivariate logistic regression analysis showed that age, CAS and the time spend in ICU were independent risk factors for POCD, especially CAS(OR=5.078,95%CI:2.211-11.662, P<0.001). Patients with severe CAS suffer from a significant decline in cognitive function on space, time, action and ideation. Conclusion CAS is a predominant risk factor for POCD in patients undergoing OPCABG.

Arbuscular mycorrhizal fungi(AMF) are ancient,asexual,and obligate symbiotic endophytes which have not been cultured in vitro.So there is some limitation in the study of mycorrhizology.While the molecular technology based on DNA analysis could increase the detection sensitivity and specificity of AMF.rDNA sequence homology and variability can reveal the relationship between species and their evolution.Thus rDNA sequence analysis are widely used in the classification,identification,genetic,ecology and bio-diversity of AMF.This article summarizes the rDNA sequence analysis techniques and their application in phylogeny,molecular detection and community structure of AMF in different plant vegetation.