OBJECTIVE To understand operating room management conditions and put forward improvement methods at township hospitals.METHODS An observatory study was conducted in 9 township hospitals using the evaluation criteria based on the requirements of the Guidelines for Disinfection in Hospitals.Technical Guidelines for Prevention and Control of the Hospital Infection in Operation Departments and the Guidelines for Hand Hygiene of Medical staff in Medical Institutions.RESULTS Problems were found to a different extent in all of the 9 township hospitals:faults in rules and regulations,unreasonable layout technological process,unstandardized sterilization and disinfection and short knowledge about hospital infection.CONCLUSIONS Special attention to managment of operating room,improving consciousness,strengthening medical staff study and improving system are the key issues for improving the management level of operating room at township hospitals.

Objective To explore the clinical effect of small incision extracapsular cataract extraction combined with implantation of artificial lens and phacoemulsification combined with implantation of artificial lens for patients with cataract.Methods One hundred and ten patients (142 eyes) with cataract were selected,55 patients (69 eyes) were treated with small incision extracapsular cataract extraction combined with implantation of artificial lens (observation group),and 55 patients (73 eyes) were treated with phacoemulsification combined with implantation of artificial lens (control group).After treatment,the corrected vision and quality of life were observed 1-week,1-and 3-month after operation,and the complications were recorded.Results The vision 0.6-1.0 of 1-week,1-and 3-month in observation group were 34 eyes (49.3％,34/69),61 eyes (88.4％,61/69) and 63 eyes (91.3％,63/69) respectively,in control group were 37 eyes (50.7％,37/73),64 eyes (87.7％,64/73) and 65 eyes (89.0％,65/73) respectively,there were no statistical differences (P ＞0.05).The quality of life score 1-week,1-and 3-month in observation group were (87.5 ± 10.7),(91.2 ± 5.3),(94.3 ± 5.8) scores respectively,in control group were (85.9 ± 11.5),(90.6 ± 6.7),(94.5 ± 6.0) scores respectively,there were nostatistical differences (P ＞ 0.05).The rate of complications in observation group was 23.2％ (16/69),in control group was 37.0％ (27/73),there was statistical difference (P ＜ 0.05).Conclusions The vision recovery and quality of life in cataract patients treated with small incision extracapsular cataract extraction combined with implantation of artificial lens are similar to treated with phacoemulsification combined with implantation of artificial lens.However,with fewer complications,small incision extracapsular cataract extraction combined with implantation of artificial lens is a more safe and reliable treatment method.

Objective Hyperglycemia was common during acute myocardiai infarction (AMI). This study investigated the impact of stress hyperglycemia on in-hospital outcomes in patients without diabetes hospitalized with AMI. Methods The study included 107 patients with AMI without diabetes, who were admitted to 81 hospital of PLA of Nanjing, China from January 2000 to May 2010. The in-hospital mortality and in-hospital complications were analyzed retrospectively. The exclusion criteria were: (1 ) patients < 18 years old; (2) patients with history of diabetes; (3) patients who initiated anti-hyperglycemic therapy during their hospital stay though without previously diagnosed diabetes; (4) patients with non-cardiovascular causes for AMI; (5) patients with hepatic failure, kidney failure, serious lung illnesses and end stage of malignant tumour; (6) patients administrated with steroid treatment recently and those with some diseases which had dramatic effect on glucose metabolism such as hyperthyroidism and cushing syndrome. Patients were categorized according to FBG levels into4 mutually exclusive groups; <7.0 mmol/L, ≥7.0 but <8.0 mmol/L, 8.0 to< 11. 1 mmol/L and ≥11.1 mmol/L. The Statistical Package for Stata, version 9.2 was used for statistical analysis. According to corresponding data analysis of /-test, ANOVA, rank test and exact propability were used respectively. Univariate logistics regression analysis was conducted followed by multivariate logistics regression analysis on significant variables. Results The incidence rate of stress hyperglycemia in patients with AMI without diabetes was 43. 9% (n =47). In non-diabetic patients, the mortality of the group of FBG≥7. 0 mmol/L was significantly higher than the group of FBG < 7. 0 mmol/L, which are 27.66% and 6.67%(P=0.0063)respectively,OR=5.35(95%CI 1.61 - 17.75,P = 0.0061). In-hospital complications for example lung infection, congestive heart failure, serious arrhythmias and acute cerebrovas-cular events were increased significantly in AMI patients with stress hyperglycemia. Multivariate logistic regression analysis for mortality were performed adjusting for risk factors which demonstrated FBG was a independent risk factors of in-hospital death , OR = 1.56(95%CIl.09 -2.23). Conclusions In-hospital mortality and in-hospital complications were significantly increased in patients with AMI without diabetes which developed stress hyperglycemia. Stress hyperglycemia was of great prognostic value for short-outcomes of AMI.

ObjiectiveTo investigate the clinical efficacy of Chinese medicineShuxin-Huoxue decoction on coronary heart disease and angina pectoris.MethodsThis study was a randomized controlled trial. 86 patients with coronary heart disease and angina pectoris and conformed to the indusive criteria were randomly divided into a control group and a treatment group, with 43 cases in each group. The control group was treated with conventional western medicine, the treatment group was treated with traditional Chinese medicineShuxin-Huoxue decoction. Serum homocysteine (Hcy) was measured by enzymatic cycling assay, high sensitive C reactive protein (hs-CRP) was measured by immunotubidimetric assay and left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), cardiac index (CI) were measured by color doppler echocardiography before and after treatment. The clinical effect of the two groups was evaluated.ResultsThe total effective rate of the treatment group and the control group was 90.7% (39/43) and 74.4% (32/43) respectively,there was significant difference (χ2=3.957,P=0.047). Followed up for 4 weeks, LVEF(65.7% ± 8.7% vs. 61.5% ± 8.4%,t=2.277), SV(86.9 ± 16.8 ml vs.79.2 ± 16.5 ml,t=2.144), CO(49.3 ± 9.1 ml/m2 vs. 44.7 ± 8.8 ml/m2,t=2.383), CI (3.7 ± 0.9 L/min?m2 vs. 3.3 ± 0.7 L/min?m2,t=2.301) of the treatment group were significantly improved after treatment than those of the control group (P<0.05), and the decrease of serum Hcy  (8.7± 3.7mmol/L vs. 11.4± 3.5mmol/L,t=3.476), hs-CRP (2.7± 1.1 mg/L vs. 3.5± 1.3 mg/L,t=3.081) level of the treatment group were better than those of the control group(P<0.01).ConclusionTraditional Chinese medicineShuxin-Huoxue decoction has good therapeutic effect on coronary heart disease and angina pectoris.

Objective To compare the effect of cisplatin or nedaplatin combined with paclitaxel as an adjuvant chemotherapy for cervical cancer.Methods Total 160 patients with cervical cancer in Ningqiang County Tianjin Hospital from February 2011 to December 2015 were divided into two groups according to different treatments.Cisplatin group was treated with TP chemotherapy,nedaplatin group was treated with TN chemotherapy,the curative effect,adverse reaction of chemotherapy,hospitalization time and treatment costs were compared between the two groups.Results The effective rate of cisplatin group was 79.26％ and nedaplatin group's was 82.05％,the two groups had no significant difference;The incidence of Ⅰ-Ⅳ grade hemoglobin,leukocyte of nedaplatin group were significantly higher than those in the cisplatin group (P ＜ 0.05),but between the two groups Ⅲ and Ⅳ grade had no significant difference,the incidence of Ⅰ-Ⅳ grade and Ⅲ-Ⅳ grade nausea,vomiting of nedaplatin group were significantly lower than cisplatin group (P ＜ 0.05);The hospitalization time of nedaplatin group was significantly shorter than cisplatin group (P ＜ 0.05),The cost of treatment between nedaplatin group and cisplatin group had no significant difference.Conclusion Cisplatin or nedaplatin combined with paclitaxel has similar efficacy in the neoadjuvant chemotherapy for cervical cancer,gastrointestinal adverse reactions of nedaplatin are lower than cisptatin,bone marrow suppression increase but still can be controlled,nedaplatin chemotherapy can shorten the duration of hospitalization,and hospitalization expenses were not significantly increased,which makes it more easily accepted by patients.

Objective: To investigate the protective effect of trimetazidine on experimental myocardial ischemia and its mechanism. Methods: Fifty mice received isoproterenol (20 mg?kg -1 ?2 d,ip) were divided into control and treatment groups. The myocyte ultrastructure,serum creatine phosphokinase (CK) activities and lactate dehydrogenase (LDH), myocardial malondialdehyde (MDA) and superoxide dismutase (SOD) were observed in 3 groups. Results: Compared with the controls,in 2 groups pretreated with trimetazidine (5 mg?kg -1 ?d -1 and 10 mg?kg -1 ?d -1 ? 7 d, ip), the degree of myocardial damage were significantly reduced;the serum CK and LDH were lower;the myocardial MDA was lower;the myocardial SOD was higher. Conclusion: Trimetazidine can significantly reduce the degree of myocardial damage produced by isoproterenol;and it may play an important role in protecting ischemic myocardium, the mechanism may be associated with reduced oxygen free radical production.

Analyzing and discriminating incorrect cases is a good method in medical statistics teaching,which can not only help students review the knowledge they have learned but also guide their self-learning.Teachers can start teaching based on the reverse thinking,propose incorrect cases with moderate difficulty and in accordance with the reality and arouse students' creativity through introducing the incorrect cases,reviewing the incorrect cases and conducting group discussion.

Objective To study the influence of hemodiafiltration on high-sensitivity C-reactive protein (hs-CRP),serum parathyroid hormone (iPTH) and cardiac function in uremic patients undergoing maintenance hemodialysis (MHD).Methods Forty patients with uremia were divided into hemodiafiltration (HDF) group (n =20) and hemodialysis(HD) group(n =20) by random numbers.Serum hs-CRP and iPTH were measured before treatment and at 6 months after treatment.Their left ventricular diastolic diameter (LVEDD),left ventricular end-systolic dimension (LVESD),interventricular septal thickness (IVST) and left ventricular ejection fraction(LVEF) were measured by echocardiogram.Ten healthy volunteers were recruited as the normal controls.Results After treatment,serum hs-CRP and iPTH decreased significantly in the HDF group (hs-CRP:(3.32±1.t4) mg/L vs.(7.84 ±2.21) mg/L,t =2.072,P =0.046;iPTH:(155.36 ±81.33) ng/L vs.(190.25 ±82.31) ng/L,t =2.121,P =0.023).No significant difference of serum hs-CRP and iPTH was observed in the HD group before and after treatment (hs-CRP:(7.91 ±2.11) mg/L vs.(7.68 ± 1.86) mg/L,t =1.731,P =0.111 ; iPTH:(177.43 ± 85.43) ng/L vs.(184.35 ± 87.21) ng/L,t =1.331,P =0.210).Color Doppler indices of cardiac structure of the HDF group significantly improved after treatment compared with before treatment (LVEDd:(55.3 ±3.7) mm vs.(58.8 ±4.3) mm,t =2.345,P =0.015 ;LVESd:(33.5 ±2.6) mm vs.(36.4±4.3) mm,t=2.178,P=0.046;IVST:(10.2±1.7) mmvs.(13.1 ±1.8) mm,t=2.630,P=0.012;LVEF:(55.3 ±2.6)％ vs.(42.5 ±3.3)％,t =2.860,P =0.010;LVMI:(132.5 ±9.1)g/m2 vs.(137.4 ± 8.7) g/m2,t =2.871,P =0.009).After treatment,cardiac structure of the HDF group was significantly better than that of the HD group (LVEDd:(55.3 ± 3.7) mm vs.(59.1 ± 4.2) mm,LVESd:(33.5 ±2.6) mm vs.(36.1 ±3.4) mm,IVST:(10.2±1.7) vs.(12.4 ±1.3) mm,LVEF:(55.3 ±2.6)％vs.(43.4±2.7)％,LVMI:(132.5 ±9.1) g/m2 vs.(139.4 ±8.9) g/m2;P ＜0.05).During the six month treatment,the incidence rate of cardiovascular events of the HDF group was significantly less than the HD group (36.39％(524/1440) vs.(72.08(1038/1440),x2 =21.583,P＜0.01).Conclusion HDF may efficiently remove iPTH,improve cardiac function of uremic patients,and help them recover from micro-inflammatory state.

Objective To systematically compare propofol and isoflurane for myocardial protection in patients undergoing coronary artery bypass grafting (CABG).Methods Electronic databases were searched for randomized controlled clinical trials comparing propofol and isoflurane for myocardial protection in patients undergoing CABG.Data which were extracted independently by two reviewers included the general data of patients,premedication,induction of anesthesia and anesthetics applied during maintenance of anesthesia,level of cardiac troponin I (cTnI) before operation and at 6,12,24 and 48 h after operation,requirement for positive inotropic agents during operation,and development of myocardial infarction within 24 h after operation.Meta-analysis was conducted using Review Manager 5.0.2.Results Sixteen randomized controlled clinical trials involving 794 patients were included in this meta-analysis.The patients were divided into 2 groups:propofol group (n =405) and isoflurane group (n =389).There were no significant differences between the two groups in the plasma concentration of cTnI after operation,incidence of myocardial infarction within 24 h after operation,and requirement for positive inotropic agents during operation (P ＞ 0.05).Conclusion There is no significant difference between propofol and isoflurane for myocardial protection in the patients undergoing CABG.