Complications of vascular access are main component of vascular complication in percutaneous cardiovascular intervention.The common complications of femoral access may include hemorrhage and hematoma at access site,vasovagal reflex,pseudoaneurysm,arteriovenous fistula,retroperitoneal hematoma and deep venous thrombosis.The common complications of radial access may include radial artery spasm,radial artery occlusion,vascular injuries or hematoma at forearm and other sites,and osteofascial compartment syndrome.The common complications of ulnar and brachial accesses may include hemorrhage and hematoma at access site,upper limb and hand ischemia,and nerve injuries.Effective prevention and treatment of vascular access complications are key steps to minimize the incidence and hazards of vascular complications in percutaneous cardiovascular intervention.

Objective To investigate the association between renin-like activity (RA) and angiotensin Ⅱ (AⅡ) and the ovarian hyperstimulation syndrome (OHSS). Methods Blood samples were taken from 42 patients undergoing in vitro fertilization (IVF). According to the ovarian stimulating response, the patients were divided into 4 groups: group Ⅰ, low responders, 7 cases; group Ⅱ, moderate responders, 8 cases; group Ⅲa high responders without using albumin, 7 cases, group Ⅲb, high responders with albumin, 10 cases; group Ⅳ, severe and moderate OHSS, 10 cases. 5 patients for intrauterin insemination with natural cycle as control. Follicular fluid (FF) was collected at oocyte retrieval from 28 IVF patients (including 7 OHSS patients). Fluid from ascites and hydrothorax was obtained from 3 OHSS patients, and peritoneal fluid obtained from 5 infertility patients by laparoscopy and ascitic fluid obtained from 6 ovarian carcinoma patients served as control. RA and AⅡ levels were measured by radioimmunoassay. Results plasma RA and AⅡ levels at mid-luteal phase from OHSS patients [(19.9?19.0)?g?L -1 ?h -1 and (397.0?378.2) ng/L] were significantly higher than those from the other patients ( P

Objective To investigate the value of fasting plasma glucose (FPG) in 75 g oral glucose tolerance test (OGTT) on the diagnosis of gestational diabetes mellitus (GDM).Methods Data of 6516 pregnant women who accepted prenatal cares from Beijing Obstetrics and Gynecology Hospital,Capital Medical University between Jan.2010 and Dec.2010 were collected.All patients had normal FPG at first trimester,and accepted 75 g OGTT after abnormal 50 g glucose challenge test (≥7.8 mmol/L).According to the result of OGTT,they were divided into 12 groups,and Chisquare test was used to analyze the role of FPG of OGTT in GDM diagnosis.Results According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria,15.0％ (980/ 6516) of this group of pregnant women was diagnosed with GDM by FPG (≥5.1 mmol/L) of OGTT in this study.Then,the rest 5536 pregnant women with normal FPG of OGTT were divided into 12 groups according to FPG level (FPG level interval 0.1 mmol/L).As FPG level rose,the incidence of GDM also rose (X2 =282.175,P =0.000).Similar results also appeared when the interval was 0.2 mmol/L and the FPG level was between 4.0 and 4.8 mmol/L (X2 =274.364,P=0.000).When FPG level was lower than 4.2 mmol/L(22.1％,1226/5536),the incidence of GDM diagnosed by OGTT was 3.6％ (44/1226).And when FPG level of OGTT was higher than 4.8 mmol/L,the incidence of GDM was 26.2％ (298/1138).Conclusions FPG screening is recommended between 24 and 28 gestational weeks before OGTT,and GDM low-risk women whose FPG ≤4.2 mmol/L do not need OGTT.

By studying the physician-related factors in physicianpatient relationship,authors put forwards that excellent medical skill,good medical ethics,favorable communication ability,and adequate knowledge on relevant legal regulations are four key points to handle the physician-patient relationship harmoniously.This article will supply reference from the above aspects for the all-around quality-based education for medical students.

Objective To explore the effect of arginine vasopressin(AVP) on proliferation and nitric oxide(NO) synthesis in rat cardiac fibroblasts(CFs). Methods CFs were isolated by trypsin digestion method. The effect of AVP on proliferation and NO synthesis were measured by MTT technique and nitric acid reductase method respectively. Results The MTT OD values of CFs increased in a concentration-dependent manner with the rising of the concentration of AVP and in a time-dependent manner with the prolongation of the culture time. For example, the MTT OD values of 10 -6 mol/L AVP group were higher than those of the control, and the MTT OD values of CFs cultured for 36h were significantly higher than those cultured for 6h when intervened with 10 -7 mol/L AVP. The content of NO of CFs displayed the same change as the MTT OD values. The contents of NO in 10 -7 mol/L and 10 -6 mol/L AVP groups were statistically higher than those of the contral group, 10 -9 mol/L AVP group and 10 -8 mol/L AVP group. The NO contents of CFs cultured for 24h and 36h were significantly higher than those cultured for 6h and 12h. Conclusion AVP can stimulate the proliferation of CFs and the synthesis of NO in neonatal rat. The enhancement of NO contents would inhibit CFs proliferation and myocardial fibrosis induced by AVP.

AIM: To explore the effects of tumor necrosis factor-? (TNF-?) on inducible nitric oxide synthase (iNOS)-nitric oxide (NO) system activity in arginine vasopressin (AVP)-induced rat cardiac fibroblasts (CFs). METHODS: CFs were isolated by trypsin digestion method. Nitrate reductase method, spectrophotometry and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect NO contents, NOS activity and iNOS mRNA expression, respectively. RESULTS: AVP significantly increased iNOS mRNA expression, NOS activity and NO contents in CFs. Combined with AVP, TNF-? enhanced the effects of AVP on iNOS-NO system activity in a concentration-dependent manner. However, if the concentration of TNF-? was too high, the iNOS-NO system activity did not increase accordingly, but slightly decreased instead. CONCLUSION: TNF-? stimulates iNOS-NO system activity in coordination with AVP in CFs. The enhancement of NO contents inhibits ventricular remodeling induced by AVP and TNF-?. [

OBJECTIVE:To observe the protective effect of ketamine and dexamethasone on lung injury in esophageal cancer thoracotomy. METHODS:60 patients with one-lung ventilation thoracotomy were randomly divided into 4 groups:blank group (group S),ketamine group(group K),dexamethasone group(group D)and ketamine and dexamethasone group(group KD)by number. After surgery,the patient-controlled epidural anaigesia (PCEA) was used to record the concentrations of IL-6,IL-8, TNF-α with the time point of preoperative 30 min (T0),60 min after one-lung ventilation (OLV)(T1),120 min after the OLV (T2),2 h after restore double-lung ventilation(T3),the changes of respiratory index(RI)in blood gas analysis and the analgesic effect and adverse reactions in 48 h after treatment. RESULTS:There was no obvious difference between the blood pressure and heart rate in 4 groups. Compared with T0,the RI values in T1,T2 and T3 were increased;compared with group KD,the RI values in T2 and T3 in group K,group D and group S were increased;compared with T0,the concentrations of IL-6 and IL-8 in T1,T2 and T3 were increased(P<0.05);compared with group S,the concentrations of IL-6 and IL-8 in T1,T2 and T3 in group D,group F and group KD were decreased(P<0.05);compared with group KD,the concentrations of IL-6 and IL-8 in T2 and T3 in group D and group K were higher(P<0.05),there was no significant difference between group D and group K(P>0.05)and the con-centration of TNF-α in 4 groups was lower than minimum detectable concentrations;compared with group KD,the scores of anal-gesia visual analogue scale(VAS)and Prince-Henry in postoperative 48 h in group K and group S were higher(P<0.05);com-pared with group D,group S and group K,the total number of press PCEA and the total amount of analgesic in group KD were de-creased (P<0.05) and the incidence of postoperative nausea was low (P<0.05);there was no significant difference in the inci-dence of postoperative delirium in 4 groups (P>0.05). CONCLUSIONS:Ketamine and dexamethasone can reduce the release of inflammatory mediators,decrease the RI values,increase the analgesia effect and has certain protective effect on lung injury.

Objective To analyze the epidemic characteristics of multidrug-resistant tuberculosis(MDR-TB)in Hunan Province from 2013 to 2016,and provide theoretical basis for the prevention and control of tuberculosis.Methods Information about TB patients in Hunan Province reported by China Information System for Disease Control and Prevention between January 2013 and December 2016 was analyzed retrospectively.Results From 2013 to 2016,the total drug resistance registration rate in Hunan Province was 5.53/million(1 496/270 330 000),multidrug registration rate was 5.40/million(1 459/270 330 000),drug resistance rate and multidrug resistance rate showed an upward trends(trend x2 =113.605,96.590,respectively,both P<0.001).Among MDR-TB patients,male were more than females(74.09%vs 25.91%),most were more than 25 years of age,especially 45～age group(27.07%);the proportion of patients with MDR-TB retreatment was higher than that of the initial treatment(69.91%vs 30.09%).From 2013 to 2016,distribution range of MDR registration rates in different regions were 4.07/million-7.23/million.Conclusion MDR-TB in Hunan Province in 2013-2016 is increasing year by year,and mainly concentrate on young people over 20 years old.There are more cases of male and retreatment;it is necessary to strengthen regular treatment and prevention of key population,enhance the ability to identify and diagnose MDR-TB patients,and reduce the spread of MDR-TB.

Objective:To establish an UPLC method for the simultaneous determination of andrographolide sulfonate E and an-drographolide sulfonate F in andrographolide sulfonates. Methods: The sample was separated on a Shimadzu Shim-pack XR-ODSⅢcolumn (2. 0 m × 75 mm, 1. 6 μm) with acetonitrile( A) and potassium dihydrogen phosphate buffer solution( B:1. 361 g potassium dihydrogen phosphate and 1. 0g heptane-1-sodium sulfonate were dissolved in 1 000 ml water) as the mobile phase with gradient elu-tion, and the flow rate was 0. 4 ml·min-1 ,the column temperature was 30℃, and the detection wavelength was set at 225nm. Re-sults:The linear range of andrographolide sulfonate E was 4. 39-43. 88μg·ml-1(r=1. 000 0) and the average recovery was 98. 71%(RSD=1. 41%, n=6). The linear range of andrographolide sulfonate F was 4. 43-44. 32 g·ml-1(r=1. 000 0) and the average re-covery was 99. 29%(RSD=0. 76%, n=6). Conclusion:The method is reproducible, sensitive and accurate, which can be used in the quality control of andrographolide sulfonates.

Objective To investigate the effect of preoperative acute hypervolemic hemodilution with 6% hydroxyethyl starch 130/0.4(HES130/0.4)and polygeline on hemodynamic response and variance regularity of hemodynamic response in open-and close-thoracic cavity in undergoing thoracotomy patients. Methods Sixty patients undergoing thoracotomy,ASA physical status ⅠorⅡ,aged 20~65 yeansold,weighing 45~70kg,were randomly divided three group:HES130/0.4 group ( group A,n=20) ,Polygeline group ( group B,n=20) and Ringer's solution group (group C,n=20).They were respectively infused 20ml/ (kg?h) with HES130/0.4,polygeline and Ringer's solution in one hour before infuseing followed Ringer's 10ml/ (kg?h). The Blood Pressure (BP) and heart rate (HR) were recorded.RPP was calculated before induction(baseline),5min before and 10 min after open thoracic cavity,5min before and 10min after close thoracic cavity. And central venous pressure (CVP) was measured at immediately after deep venous puncture ,5min before and 10min after open thoracic cavity,5min before and 10min after close thoracic cavity. Results The changes of hemodynamics in Ringer's solution group in operation were obvious as compared with baseline before operation.HES130/0.4 and polygeline were relatively stable.Two groups had no significant difference.The CVP of HES130/0.4 and polygeline groups increased obviously before and after open thoracic cavity,but the blood pressure was relatively stable.Only systolic blood pressure increased obviously as compared with Ringer's solution group at 5min before open thoracic cavity. At 10min after open thoracic cavity,HR and CVP in three groups increased obviously as compared with 5 min before open thoracic cavity.At 5 min before close thoracic cavity,blood pressure and CVP in three groups decreased obviously as compared with 10 min after open thoracic cavity. Conclusion The preoperative acute hypervolemic hemodilution with HES 130/ 0.4 and polygeline in undergoing thoracotomy patients can keep hemodynamics more stable and improve tolerance of patients to withstand hypovolemics.