Objective To study the relationship between insulin resistance with cardiac function and cardiovascular events in the patients with obstructive sleep apnea syndrome(OSAS).Methods Eithy-eight cases of SHAS in our hospital from August 2015 to August 2016 were selected as the research subjects,and contemporaneous 20 persons undergoing healthy physical examination served as the control group.The blood glucose metabolism indicators were detected for evaluiating the level of insulin resistance.The insulin resistance and glucose metabolism indexes were compared between the two groups.The relatioship between insulin resistance with cardiac function and cardiovascular events in the OSAS was investigated.Results BMI,HOMA-IR,FPG and FINS in the observation group were (28.1± 3.9),(4.7 ±1.9),(4.8± 0.9) and (19.8± 3.7) respectively,which were significantly higher than those in the healthy control group,LVEF in the observation group was (58.7±5.6)%,which was significantly lower than that in the control group,LVEDP,RVEDP and mPAP in the observation group were 8.6±1.8,5.4±0.9 and 25.4±1.9 respectively,which were significantly higher than those in the control group,the multivariate analysis results indicated that LVEF<55%(P=0.014) and HOMA-IR>4.5(P=0.04) were the independent risk factors for cardiovascular events in OSAS patients.Conclusion The insulin resistance has obvious correlation with the cardiac function in OSAS patients.

Objective To observe the effect and the influence on PCT,CRP in the treatment of patients with acute exacerbation pulmonary disease by Budesonide and ipratropium bromide.Methods 80 patients with acute exacerbation pulmonary disease were randomly divided into 40 cases of the control group and 40 cases of the observa-tion group,the two groups were given routine treatment,the control group then had been given ipratropium bromide for 7d,and the observation group had been given Budesonide and ipratropium bromide for 7d,the blood gas indicators (PaO2 ,PCO2 ),pulmonary function (FEV1 ,PEF,FEV1 /FVC),dyspnoea and exercise tolerance score,serum PCT levels,serum CRP levels and clinical efficacy were compared,Adverse reactions were recorded.Results (1 )the PaO2 ,FEV1 ,PEF,FEV1 /FVC of the observation group and the control group after treatment were (70.7 ±2.3)mmHg and (62.5 ±3.0)mmHg,(2.15 ±0.63)L and (1.76 ±0.56)L,(3.49 ±0.82)L/s and (3.06 ±0.75)L/s, (68.52 ±6.53)% and (60.14 ±6.03)%,These indicators were significantly higher than those before treatment,all P <0.05,the PCO2 ,PCT,CRP were (51.4 ±1.7)mmHg and (56.6 ±2.3)mmHg,(1.75 ±1.20)μg/L and (2.58 ± 1.17)μg/L,(10.25 ±6.77)mg/L and (19.07 ±5.75)mg/L,These indicators were significantly lower than those before treatment,all P <0.05,the PaO2 ,FEV1 ,PEF,FEV1 /FVC of the observation group were significantly higher than those of the control group,the PCO2 ,PCT,CRP were significantly lower than those of the control group,all P <0.05;(2)The dyspnoea and exercise tolerance score of the observation group and the control group after treatment was significantly lower than those before treatment,the dyspnoea and exercise tolerance score of the observation group was significantly lower than those of the control group;(3)The clinical total effective rate of the observation group was 90%,which was higher than 65% of the control group(χ2 =7.312,P <0.05).Conclusion The method containing Budesonide and ipratropium bromide Inhalation has exact effect,and can effectively improve respiratory function, which is an effective treatment of choice for acute exacerbation of COPD.

Objective:To explore the effect of micro-video education combined with active psychological management on the rehabilitation effect of hip replacement.Methods:From January to December 2018, 100 patients with total hip arthroplasty were divided into control group and observation group, 50 cases in each group. The control group was given routine nursing, and the observation group was given micro video education combined with positive psychological management. The depression, pain, joint function and complications were evaluated.Results:After the intervention, the Self-rating Depression Scale (SDS) score of patients in the observation group was (34.72±6.83) points, which was significantly lower than (40.58±7.59) points of the control group. The difference was statistically significant ( tvalue was 4.058, P<0.05); pain control education in the observation group and satisfaction scores for pain control or reduction methods were (43.01±5.72) and (63.77±8.62) points respectively, which were better than the control group's (33.96±4.58) and (55.15±9.27) points. The difference was statistically significant ( tvalues were 8.733, 4.815, P<0.05); the excellent and good rate of hip joint function in the observation group was 90.00% (45/50), which was higher than 64.00% (32/50) in the control group. The difference was statistically significant ( χ 2value was 4.336, P<0.05); the complication rate in the observation group was 2.00% (1/50), which was significantly lower than the control group's 18.00% (9/50). The difference was statistically significant ( χ 2value was 7.111, P<0.05); The scores of each item of quality of life in the observation group were higher than those in the control group, and the differences were statistically significant ( tvalues were- 9.859 to- 3.154, P<0.01). Conclusion:Micro video education combined with positive psychological management can improve the depression of patients after hip arthroplasty, reduce the degree of joint pain, promote the function of hip joint and reduce complications.

Objective To investigate the effect of ulinastatin on the renal function during perioperative period in infants undergoing open heart surgery under CPB.Methods Forty ASA Ⅱ infants (25 male, 15 female)aged 3-5 months weighing 5.3-6.8 kg undergoing open heart surgery under CPB were randomly divided into 2 groups (n = 20 each): control group (group C) and ulinastatin group (group U). Ulinastatin 20 000 U/kg in normal saline 20 ml was infused iv in 3 parts (1/3 was infused via CVP line when the catheter was successfully placed in the internal jugular vein; 1/3 at the beginning of CPB and 1/3 at aortic unclamping). Blood and urine samples were collected at 30 min before incision ( T1 ), 5 min before aortic clamping (T2 ), 5 min after aortic unclamping (T3 ), at the end of operation (T4) and 24 and 48 h after operation (T5, T6 ) for determination of serum urea nitrogen (BUN) and creatinine (Cr) and urinary N-acetyl-β-D-glucosaminidase (NAG) and β2-microglubin (β2-MG) levels. Results There was no significant difference in serum BUN and Cr concentrations between the two groups. The urinary β2-MG concentration and NAG activity were significantly increased at T2-6 as compared with baseline values at T1 in both groups. The urinary β2-MG concentration and NAG activity were significantly lower in group U than in group C at T3-5 . Conclusion Ulinastatin can protect the renal function during perioperative period in infants undergoing open heart surgery under CPB.

Objective To investigate the effect of tramadol on the expression of 5-HT1A receptor in the distal'cerebrospinal fluid contacting neurons (CSF-CNs) in mid-brain in a rat model of neuropathic pain. Methods Forty male SPF SD rats weighing 220-280 g were randomly divided into 5 groups (n = 8 each): group Ⅰ normal control (group C); group Ⅱ normal saline (group NS); group Ⅲ tramodol (group T); group Ⅳ neuropathic pain + normal saline (group NP+ NS) and group Ⅴ neuropathic pain + tramadol (group NP + T). Neuropathic pain was induced by chronic constrictive injury (CCI) in group Ⅳ and Ⅴ . Four silk ligatures were placed on the sciatic nerve at 1 mm intervals. In group Ⅱ (NS) and group Ⅲ (T) the sciatic nerve was exposed but not ligated and NS 2 ml/kg and tramadol 10 mg/kg were injected IP respectively, while in group Ⅳ and Ⅴ NS 2 ml/kg and tramadol 10 mg/kg were injected IP respectively on the 7th day after CCI. Paw withdrawal threshold (PWT) to von Frey filament stimulation and paw withdrawal latency (PWL) to noxious thermal stimuli were measured before (T1) and after IP NS or tramadol injection (T2) in group Ⅱ-Ⅴ. The distal CSF-CNs in the mid-brain was labelled with 30% cholera toxin subunit B and horseradish peroxidase compound (CB-HRP) 3 μl injected in left lateral cerebral ventricle. The expression of 5-HT1A receptors was measured by immuno-histochemistry. Results PWT and PWL were significantly decreased after CCI in group Ⅳ (NP + NS) and tramadol significantly inhibited the mechanical and thermal hyperalgesia in group Ⅴ (NP + T). There was no significant difference in the number of distal CSF-CNs among the 5 groups. CCI significantly down-regulated the expression of 5-HT1A in distal CSF-CNs in group Ⅳ(NP+ NS) as compared with group Ⅰ , Ⅱ and Ⅲ and tramadol significantly inhibited the CCI-induced downregulation of 5-HT1A receptor expression. Conclusion Tramadol can ease neuropathic pain by down-regulating the expression of 5-HT1A receptor in distal CSF-CNs in mid-brain.

ObjectiveThe purpose of this study is to discuss the diagnostic accuracy of nornalized liver ADC using the spleen and renal cortex as reference organs for the diagnosis of liver fibrosis.Methods Forty three patients with liver disease (chronic liver disease group) at compensated stage and 10 healthy volunteers (control group) were retrospectively assessed with diffusion-weighted imaging at a 3.0 T MR unit.Liver ADC,spleen ADC,renal ADC and normalized ADC (defined as the ratio of liver ADC to spleen ADC or renal cortex ADC,S-ADC and R-ADC for short) were measured in patients stratified by fibrosis stage.Spearman analysis was used to see the correlation between fibrosis stages and ADC,one-way ANOVA was used to compare the ADCs in different fibrosis stages.Logistic regression analysis was used to determine the performance of ADC for prediction of liver fibrosis,and show the area under the curve ( AUC),sensitivity and specificity choosing the optimal cutoff value that maximized the Youden index.ResultsTen volunteers belonged to SO stage.From SO to S4 stage,there were 2,5,9,12 and 15 patients,correspondingly,liver ADCwere (1.37±0.13) ×10-3,(1.33±0.16) ×10 -3,(1.17±0.16) ×10-3,(1.23±0.14) ×10-3and ( 1.12 ±0.11 ) × 10-3mm2/s,S-ADC were 1.86 ±0.18,1.68 ±0.12,1.34 ±0.14,1.48 ±0.15 and 1.34±0.10,R-ADC were 0.71 ±0.08,0.68 ±0.12,0.61 ±0.09,0.64 ±0.11 and 0.60 ±0.08respectively,and the differences among them were significant ( F =6.48,18.70 and 3.04,P ＜0.05 ).The correlation between fibrosis stage and S-ADC was stronger than between fibrosis stage and liver ADC,R-ADC (r =- 0.71,- 0.51,- 0.41 ;P ＜ 0.01 ).S-ADC was superior to liver ADC and R-ADC for detection of S2,S3 and S4 fibrosis stage (Youden index:0.91,0.58,and 0.59).ConclusionSpleen normalized liver ADC improves diagnostic accuracy for detection of liver fibrosis than liver ADC and renal normalized liver ADC.

Objective To retrospectively analyzed the echocardiographic characteristics of ventricular diverticula in fetuses ,children and adults ,and discuss the main points of diagnoses and prognoses of ventricular diverticula . Methods Echocardiographic characteristics ,clinical data and intraoperative findings of ventricular diverticula of 8 fetuses ,3 children and 14 adults were summarized . Results The ventricular diverticula in 8 fetuses and 3 children were all single . Twenty five diverticula were found in the 14 adult patients ;in other words ,there were 3 multiple diverticula found in adult group . A statistical difference was found in ratio of diverticula area and corresponding ventricular area ( P = 0 .021 ) ,and corresponding ventricular fractional shortening ( P =0 .003) between fetal and single adult ventricular diverticula . There were 2 cases with ventricular septal defects ,1 with pericardial effusion ,1 with single umbilical artery ,and 2 with atrioventricular valvular regurgitation in fetal cases . Congenital complex cardiac disease and dextrocardia were found in 1 child . There were 1 case with supravalvular aortic stenosis , 1 with nonobstructive hypertrophic cardiomyopathy ,1 with left ventricular noncompaction ,and 1 with mitral reguigitation in adult group . All the 7 diverticula with ventricular arrhythmias ,ST‐T changes and abnormal Q wave were fibrous type . And 2 multiple diverticula were accompanied with ventricular dysfunction . Among the fetal cases ,2 cases were born ,3 cases were terminated pregnancy ,and 3 cases were lost to follow up . Three children and 2 adults were underwent cardiac operations for diverticula with good outcomes . No such complications as cardiac rupture ,thromboembolism ,and sudden death were found . Conclusions Echocardiography is a useful method to diagnose ventricular diverticulum ,especially for fetuses ,and provide the basis for prognosis consultation .

Objective To investigate the changes and correlation of mitral valve coaptation length index CLI and coaptation area index CAI after mitral valvuloplasty MVP Methods A total of 30 subjects undergoing MVP for mitral regurgitation MR were studied Coaptation length CL CLI coaptation area CA and CAI were determined before and after surgery by 2-dimensional transoesophageal echocardiography 2D-TEE and 3-dimensional transoesophageal echocardiography 3D-TEE Results Compared with preoperative measurements CL CLI CA and CAI were significantly increased in postoperative studies CL 4 7±0 7 mm vs 9 4± 1 1 mm CLI 9 1 ±3 3 vs 38 5 ±4 1 CA 148 9 ± 65 3 mm 2 vs 371 9 ± 144 3 mm 2 CAI 9 3 ±3 1 vs 35 9 ± 7 5 all P < 0 05 CLI was significantly correlated with CAI both preoperatively r = 0 770 P < 0 01 and postoperatively r = 0 771 P <0 01 Furthermore CLI and CAI were significantly negative correlated with the degree of MR r =-0 897 P <0 01 r =-0 886 P <0 01 Conclusions Coaptation variables increased significantly in subjects after MVP CLI by 2D-TEE was related to CAI by 3D-TEE and both were useful for the assessment of mitral valve coaptation But CLI by 2D-TEE was more simple and feasible in clinic.

Objective:Selected virulence factors more than and high virulent Aeromonas hydrophia strain made into inactivated vaccine,to study the immunization effect of inactivated vaccine.Methods:Crucian were vaccinated with formalin-killed vaccine via in-traperitoneal injection.Controls were injected with the same volumes of saline.Then the antibody titres, histopathology and relative percent survival were analyzed from samples of both groups.Results: The antibody in the indirect agglutination reaction could be detected in vaccinated fish once a weeks after immunization and reached highest level 6 weeks after immunization.The histopathology analysis indicated that the vaccine had a good protective effect on crucian target organs.Vaccinated fish showed 100%relative percent survival and the immune period would be 6 month.Conclusion:The vaccine in this study has a significant protective effect on crucian and may be used as effective fish vaccines against bacterial septicemia.

Objective To evaluate the quality of life for tuberculosis patients after anterior debridement, autograft bone fusion and anterolateral fixation operation. Methods 17 cases of thoracolumbar spinal tuberculosis were treated surgically from January 2008 to March 2011. All the cases underwent anterior debridement, autograft bone fusion and anterolateral fixation operation. MOS health survey 36-item Short Form (SF-36), Japanese Orthopaedic Association Scores (JOA) and Visual Analogue Scale (VAS) were used to evaluate the quality of life, spine function and pain symptom before and 1 and 6 months after surgery. Results Compared to the results 1 month after surgery, the scores of physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), role emotional (RE), and mental health (MH), and JOA subjective symptoms, JOA clinical signs, and JOA daily activity limitation, and VAS improved (P<0.05) 6 months after surgery; compared to pretreatment, the scores of PF, BP, GH, VT, SF, and MH, and JOA subjective symptoms, JOA clinical signs, and JOA daily activity limitation, and VAS improved (P<0.05). Conclusion The anterior debridement, autograft bone fusion and anterior fixation operation is effective to improve the quality of life, spine function and pain symptom for tuberculosis patients.