Objective To compare target-controlled infusion of propofol combined with remifentanil total intravenous anesthesia and intravenous combined with inhalation anesthesia in hemodynamic changes and side effects in elderly patients with laparoseopic cholecystectomy.Methods 56 ASA Ⅰ-Ⅱ patients aged ＞60 Y undergoing elective laparoscopie cholecystectomy were randomly divided into propofol-remifentanil target controlled infusion group (observation group)(n=28)and inhalation anesthesia group(using intravenous anesthesia was maintained with isoflurane inhalation)(n=28).HR,SBP,DBP,PETCO2,initial consciousness time,extubation time,side-effects were recorded at each time points.Results The change extent of HR and blood pressure in observation group was lower than inhalation anesthesia group.The initial recovery time,recovery time of spontaneous breathing and extubation time in the observation group Was better than anesthesia group(all P＜0.05).The side-effects in observation group were significantly lower than inhalation anesthesia group(all P＜0.05).Conclusion Laparoscopic cholecystectomy in elderly patients by target-controlled infusion of propofol combined with remifentanil total intravenous anesthesia could significantly inhibit the stress response,and effectively maintain the stability of hemodynamic,and rapid postoperative recovery,fewer adverse reactions.It Was an ideal anesthesia methods in elderly patients with laparoscopic cholecystectomy.

Objective To explore the clinical effect and safety of bisoprolol combined with methimazole in treatment of hyperthyroidism.Methods 100 cases with hyperthyroidism were randomly divided into control group (methimazole treatment)50 case.$and treatment group(bisoprolol combined with methimazole treatment)50 cases.The therapeutic effect,serum levels of FT3,FT4 and s-TSH were observed.Results The total effective rate in treatment group 92.0% was significantly higher than 78.0%in control group(χ2=3.798,P＜0.05);The contents of TT3,TT4,FT3,FT4 after treatment were lower than before treatment(t=2.245,2.315,2.411,all P＜0.05);The contents of S-TSH was higher than before treatment(t=2.335,P＜0.05);Hyperthyroidism exponential integral in treatment group decreased significantly than the control group(t=2.312,P＜0.05).Conclusion The bisoprolol combined with methimazole treatment could efficiently improve clinical symptoms,raise therapeutic effect in patients with hyperthyroidism.

The research on hypothyroidism during pregnancy has been a hot field concerned by endocrinologists. This editorial highlights six aspects of consensus reached by American Endocrine Association in "Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline" in 2007. The appropriate diagnosis of thyroid dysfunction depends on gestational specific reference intervals of thyroid hormones, and otherwise the pregnant women with subclinical hypothyroidism will suffer from missed diagnosis. There are three types of subclinical thyroid disorders during pregnancy, namely subclinical hypothyroidism, hypothyroxinemia and simple positive thyroid peroxidase autoantibodies. The opinions on thediagnosis of these disorders are proposed in the context.

Various academic organizations, countries, and regions have established different concepts of metabolic syndrome, including the involvement of metabolic disorders, the threshold of its constituent elements,and the utility as a research or clinical tool, etc. Additionally, uncertainty of its pathogenesis, lack of uniform diagnosis definition, and some other factors lead to concept confusion and practical inconvenience of metabolic syndrome in public health prevention and in clinical diagnosis. Consensus and controversy of metabolic syndrome were both presented in recent years. Besides literature reviewing, further evidences are essential for appropriate understanding and distinguishing. The present article mainly introduces the new controversies concerning the concept of metabolic syndrome and the recent evidence of unifying trends in the diagnosis criteria of abdominal obesity in Asians.

In many cancers the chronic inflammation caused by microorganisms can be observed, espe-cially in gastrointestinal system. Atrophic gastritis is thought to be a precancerous lesion. Studies have approved that Helicobacter pylori plays an important role in the genesis and development of gastric caner. It is now known to be responsible for inducing chronic gastric inflammation that progresses to atrophy, metaplasia, dysplasia and gastric cancer.

The laboratory measurements for the diabetes mellitus are widely used in medical practice.The laboratory measurements should be accuracy and valuable for clinician.The "Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus"would be helpful for laboratorian and clinician in the diabetes care.

Objective To explore external cerebral herniation at different times in traumatic brain injury patients after decompressive craniectomy.Methods Clinical data of 90 patients with traumatic brain injury routine hemicraniectomy were analyzed,brain incisional hernia incidence and severity in early (less than a week after surgery), medium (after 7d-30d)and late (after 1 month-June),and compare GCS score and GOS score of different periods were observed.Results Brain incisional hernia incidence in early,middle and late was 42.22%,21.11%,12.12%with significant difference(χ2 =4.312,P<0.05;χ2 =4.523,P<0.05;χ2 =4.543,P<0.05),and the severity in early was the most(P<0.01);GCS scores in early,mid and late was (3.22 ±0.41)points,(6.53 ±0.37)points, (12.05 ±0.84)points with significant difference(t=5.215,P<0.05;t=6.312,P<0.05;t=6.312,P<0.05);T test showed that the difference was existed between different period of patients.Conclusion Traumatic brain injury incidence and serivity in 1 week was the most;brain hernia occurs sooner in GCS score lower patients;prognosis was worse in later external cerebral herniation patients,so GCS score and incisional hernia occurrence time is important for improving prognosis of traumatic brain injur patients.

Objective:To evaluate the present development and service offering of community health service(CHS) institutions in Chongqing City,to find the main problems at present,and provide the solving proposal.Methods:All the CHS institutions in 35 counties of Chongqing were surveyed;the CHS institutions of main city zone were investigated by stratified random sampling,and their principals were interviewed.Results:The new health service system of two levels have been established,but there are still several problems.The total number of CHS institutions is inadequate.Foundational construction of CHS station is not good.It's widespread that CHS institutions support their medicine sevice with drugs-income and their public heath sevice with medicine-income.The public health sevice is weakened.For the dual referral system,it's easy to refer up and hard to refer down.Conclusion:At present government should increse finance aid,improve management and monitor mechanism,strengthen the foundation construction,and further consummate the training system of personnel,and a GIS System should be built to help improve the Dual Referral System.

This paper introduces the concept, characteristics and applications of fault tolerant technique, which can ensure high availability of network server.

OBJECTIVE:To explore the effects of tirofiban with different medication timing on blood flow and complications in patients with acute myocardial infarction after percutaneous coronary intervention(PCI). METHODS:214 cases of acute ST-seg-ment elevation myocardial infarction were divided into late stage group(n=98)and early stage group(n=116)based on the order of admission. Te latter was given intravenous injection of tirofiban after PCI;the former was given intravenous injection of tirofi-ban before entered emergency room [1-2 h before PCI]. The injection-balloon dilation time was compared between 2 groups. The coronary TIMI flow situation,cardiac function and microcirculatory perfusion index before and after operation,and complications during hospitalization were also compared. RESULTS:Intravenous injection of tirofiban to balloon dilation time were 3-40 min in early stage group,and 30-65 min in late stage group,with statistical significance (t=8.94,P=0.00);during angiography,the number of patients with IRA prorsal blood flow rate to reach 2 and 3 grade was 16 cases(13.8% and 20 cases(17.2%)in early stage group,which were higher than in late stage group [7 cases (7.1%),9 cases (9.2%)],with statistical significance (P<0.05). After PCI,occluded artery of 2 groups opened up,there were 2 cases of no-reflow in early stage group and 6 cases of no-re-flow;there was no statistical significance in 3 grade blood flow of TIMI between 2 groups(χ2=1.21,P>0.05). The amount of 4 and 8 h creatine kinase MB,and postoperative 24 h LVEF of 2 groups were similar after operation,without statistical significance (P>0.05);ST segment of early stage group drop value was (1.93 ± 0.57) mm,which was significantly higher than that of late stage group(1.07±0.29)mm,with statistical significance(P<0.05);the incidence of cardiac adverse events and bleeding compli-cation were 3.45%and 7.76%in early stage group,and 4.08%and 5.10%in late-stage group,without statistical significance(P<0.05). CONCLUSIONS:Different medication timing has no significant effect on the safety of tirofiban,but clinical outcomes and angiographic results are consistent. However,early treatment can improve IRA prorsal blood flow rate before PCI,which is the good medication timing of tirofiban.