Despite of great advances in drug management of heart failure in the past ten years,the condition remains a major public health issue,with high prevalence,poor clinical outcomes.Treatment of established systolic chronic heart failure includes agents that block the renin-angiotensin-aldosterone and sympathetic nervous systems to prevent adverse remodelling,to reduce symptoms and prolong survival.Diuretics,Vasodilator and Digoxin are often used to improve sign,with no influence on prognosis.Pharmacological agents aimed at new targets on clinically relevant endpoints are going under investigating.

Objective To explore the significance of blood lactic acid level and lactic acid clearance in evaluating the prognosis of septic shock.Methods The blood lactic acid concentration of 64 patients with septic shock EICU ICU admission 1h inside,6,12,24 and 48h was recorded,and the lactic acid clearance was calculated 12 hours after treatment,and according to lactic acid clearance of outcome,64 patients were divided into two groups,live group and death group;Then compared blood lactic acid level and lactic acid clearance between the two groups.Results The blood lactic acid concentration of live group and death group when enter the ICU was (7.2 ±5.4)mmol/L,(9.2 ±5.6)mmol/L respectivly,and was higher than normal,and of live group after 6h began to fall,and it reached normal level after 24h [ (2.2 ± 1.3 ) mmol/L ],but of death group after 48 h [ ( 8.0 ± 3.8 ) mmol/L ] was still significantly higher than normal,until death.There was significant difference between the two groups (t =3.7816,3.8257,7.5263,4.5875,5.8765,all P ＜ 0.05 ).The lactic acid clearance of death group after 12 hours was (5.83 ±3.92)mmol/L,and significantly lower than that of live group[ ( 14.32 ±2.68) mmol/L] (t =6.2565,P ＜0.05).Conclusion Blood lactic acid concentration was positively related to the prognosis of patients with septic shock,and dynamic response of disease progression by detecting lactic acid clearance rate could be early,sensitive,quantitative indicators to determine the severity of critical illness.

Objective To approach the relationship between the membrane protein of platelet microparticles and myocardial infarction or hypertension. Methods The contents were examined of PAC-1~ + PMP and CD62P~+ PMP by activating platelet with 20?mol/L ADP in the blood collected from the patients with myocardial infarction (n=12) and hypertension (n=10). Results The contents of PAC-1~ + PMP and CD62P~+ PMP in myocardial infarction group (85.1%?3.7%, 85.9%?3.8%) were significantly higher than normal group (75.5%?4.4%, 76.3% 5.3%) (P

With the deeper development about the local medical service , the legionary hospital ought to strengthen the search on the economic circulation to ensure the advantageous station in the competition of medical market.By modulating the intersected situation of sanitation economy and finance, legionary hospital will adjust the source of sanitation economy and finance and build the new system to support the scientific decision-making about the economic circulation.

Objective To summarize the surgical techniques to treat complex stale acetabular fractures through combined approaches. Methods From February 1993 to September 2005, 21 cases (12 males, 9 females, mean age of 33 years old) of complex stale acetabular fracture were treated with open reduction and internal fixation through combined approaches (K- L+ ilio- inguinal). Of the 21 fractures, 3 were transverse and posterior wall ones, 4 T- shaped ones, 11 both column ones, and 3 hemi- transverse and anterior column ones. Results 12 cases (57.1% ) got anatomic reduction, 5 cases satisfactory reduction (23.8% ), but 4 cases unsatisfactory reduction (19.1% ). The rates of anatomic reduction for the early 6 years and for the latest 6 years in this study were 44.4% and 66.7% respectively. 15 cases were followed up for 2 to 12 years. The excellent and good rate for clinical and roentgenographic results were 65.3% and 67.2% respectively. The clinical results for anatomic and non- anatomic reduction groups were 78.6% and 32.8% respectively (P

Firstly the paper expounds the fact that letting patients pick their doctors goes with the tide of social development: ①the connotation of medical quality determines the necessity of patients involvement; ②evaluation of medical quality has extended from self appraisal to social assessment; and ③the mechanism of letting patients pick their doctors conforms to the medical quality requirements of the times. Then the paper discusses the positive impact of letting patients pick their doctors on medical quality, including the choice of doctors by outpatients and the impossibility of doing so in medico technical and emergency departments or by inpatients. The paper also gives an account of the measures taken for safeguarding medical quality when adopting the practice of letting patients pick their doctors. Lastly the paper explains the boosting role of the practice and the difference between letting patients pick their doctors and letting them name particular surgeons for their operations.

After an account of the background to the practice of letting patients pick their doctors in the Third Central Hospital of Tianjin, the paper points out the positive impact of the practice, comments on the specific measures, and narrates the results that have been achieved. These include: ①enhanced awareness of self management on the part of the staff; ②increased cohesion of the hospital; ③higher efficiency; ④greater initiative on the part of the scientific and technical personnel as a result of the reform; ⑤social recognition of the reform; and ⑥a higher level of professional ethics building. Lastly the paper discusses the hospitals experience in adopting the practice of letting patients pick their doctors.

Objective To study the operation methods and efficacy of joint prosthesis with artificial diaphysis for the treatment of tumors at the end of bone. Methods 28 patients with tumors at the end of bone had resection and limb salvage by joint prosthesis with artificial diaphysis. These cases consisted of 11 osteosarcomas, 10 bone giant cell tumors, 2 chondrosarcomas, 2 metastatic carcinomas, 1 malignant fibrous histiocytoma,1 aneurysmal bone cyst and 1 osteochondroma. Among them, there were 7 cases of proximal femoral tumors, 6 cases of distal femoral tumors, 10 cases of proximal tibial tumors, 5 cases of proximal humeral tumors. Results The follow-up periods were 16 months to 15 years. Eighteen patients died. Functional activity was satisfactory in 71% of the patients(2 years). Conclusions Joint prosthesis with artificial diaphysis for the treatment of tumors at the end of bone is feasible, and a better system for reattachment of the soft tissues is needed to avoid pain and a persistent limp.

Objective To observe the clinical efficacy of dendritic cell-cytokine-induced killer cell (DC-CIK) combined with interleukin (IL)-2 in treatment of renal cell carcinoma.Methods A total of 60 patients with renal cell carcinoma after radical nephrectomy were randomly divided into treatment group and control group.Thirty cases in treatment group were given DC-CIK cells combined with IL-2 treatment.Thirty cases in control group were treated with IL-2 treatment.The immune function,quality of life,survival rate and adverse reactions were analyzed in two groups.Results Compared with before treatment,the percentages of CD3+,CD4+,CD4+/CD8+ ratio and CD16+CD56+ increased and CD8+ decreased significantly in treatment group(P ＜ 0.05).In control group,there was no significant change before and after treatment in the percentages of CD3+,CD4+,CD4+/CD8+ ratio,CD16+ CD56+ and CD8+(P ＞ 0.05).Quality of life of 83.3％(25/30)patients in treatment group was improved,56.7％(17/30) patients in control group was improved,there was significant difference between two groups (P ＜ 0.05).The 1-year survival rate in treatment group and control group were 93.3％ (28/30),83.3％ (25/30),and the 1-year recurrence rate in two groups were 6.7％ (2/30)and 13.3％ (4/30),there were no significant difference between two groups (P ＞ 0.05).There were no significant statistically in the incidence of adverse reactions between two groups (P ＞ 0.05).Conclusion DC-CIK cells combined with IL-2 in treatment of renal cell carcinoma after radical nepbrectomy can improve patients' immune function and quality of life.