To evaluate the influence of known coronary artery disease(CAD)on perioperative cardiac events in elderly patients undergoing noncardiac surgery,3028 consecutive patients who underwent major noncardiac procedures, with or without a history of CAD, were analyzed in terms of types and nature of surgery, clinical history and perioperative cardiac complications. Among the patients CAD, there were more urologic operations, and clinical history of internal diseases compared with the patients without CAD. Patients with CAD had an increased odds ratio for myocardial ischemia and arrhythmia (OR, 20 3 [95% CI, 6 5 to 65 7] and OR, 7 4 [CI, 4 4 to 12 3]) during operation, and also for postoperative myocardial ischemia, myocardial infarction, cardiogenic pulmonary edema and arrhythmia (OR, 8 3 [95% CI, 4 7 to 14 7], OR, 3 9 [95% CI, 1 2 to 12 2], OR, 7 9 [95% CI, 3 8 to 16 6] and OR, 1 7 [CI, 1 3 to 2 4]) compared with patients without CAD. The results indicated that elderly patients with CAD who underwent noncardiac surgery were more frequently associated with clinical history of internal diseases, and had a higher rate of major perioperative cardiac complications.

Background Macular edema is one of the serious complications of central retinal vein occlusion (CRVO),and the present therapies are laser coagulation and intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs.Conbercept is humanized-monoclonal VEGF antibody and used for the treatment of retinal vascular diseases.However,fewer studies were focused on its application in macular edema secondary to CRVO.Objective The aim of this study was to compare the effectiveness and safety of conbercept with triamcinolone acetonide(TA)by intravitreal injections for macular edema secondary to CRVO. Methods A non-randomized controlled study was carried out under the approval of the informed consent of patients.Sixty eyes of 60 patients with macular edema secondary to CRVO were included in Weifang Yidu Central Hospital from March 2012 to August 2013.The eyes were divided into the conbercept group and TA group with 30 for each group.Conbercept and TA of 0.05 ml were intravitreally injected in different groups,and the best corrected visual acuity(BCVA),central macular thickness(CMT)measured by OCT,intraocular pressure(IOP)and relavant complications were examined before injection and 1 week,1 month,3 months and 6 months after injection.The treatment outcomes were compared intergrouply and along with time. Results The BCVA was evidently better in 1 week,1 month,3 months and 6 months after injection than that before injection both in conbercept group and TA group(all at P＜0.01),and the BCVA of TA group was better than that of conbercept group 1 week after injection(P＜0.05).The CMT values of Conbercept were(572.00± 100.01),(325.12±91.55),(280.00±92.37),(258.65 ±88.65),(300.00±87.64)μm,and those of TA group were(570.00± 102.21),(345.12±89.31),(290.00±80.27),(309.65 ±84.13)and(303.00±90.59)μm,and CMT value after injection was significantly lower in 1 week,1 month,3 months and 6 months after injection than that before injection both in the conbercept group and the TA group(all at P＜0.05),and CMT value was evidently reduced in the conbercept group compared with the TA group 3 months after injection(P＜0.05).The IOP was(15.20±3.52),(21.20±3.80),(26.40±4.00),(23.60±3.73)and(21.50±3.27)mmHg in the TA group before injection and 1 week,1 month,3 months and 6 months after injection,showing significnatly elavation after injection(all at P＜0.05),and the IOP at different time points was higher in the TA group than that in the conbercept group(all at P＜0.05).However,there was no considerable change of IOP before and after injection in conbercept group(all at P＜0.05). Conelutions Both conbercept and TA are effective for macular edema secondary to CRVO by intravtreal injection.Compared with TA,conbercept is much safer because of less risk of IOP rising after intravtreal injection.

Objective: To investigate constitutional and phys ical stamina status in soldiers with different adaption periods in Tibetan areas . Methods: Two hundred and eithty-two male soldiers from a barr acks at an elevation of 3 600 m were divided into 2 groups: the veteran group ( n=143) in Tibet for 1.45±0.22 year, and the recruit group (n=139) in Ti bet for 0.33±0.00 years. The test items included body weight, cirumference, st a nding long jump, chin-up, 100 m dash and 3 000 m jogging, all were evaluated ac cording to the national military standard, which were Comprehensive Evaluation o f Health in Troops, and Examination and Evaluation of the Physical Stamina of So ldiers. Results: The physical stamina indexes of both the vetera ns and the recruits were up to the national military norm on the whole, ranking as moderate. The veteran group showed no significant difference in standing long jump and 100 m dash,（P<0.05), but obvious lower level in chin-up and 3 00 0 m jogging（P<0.01）, compared with the national military norm. The recr ui t group showed significant lower level in chin-up, 100 m dash, 3 000 m jogging as compared with the national military norm（P<0.01）, and also significant lower level in chin-up and 3 000 m jogging （P<0.05 or P<0.01) as compa red with the veteran group. Conclusion: The physical stamina of both the veterans and the recruits meet the basic national military requirements , ranking as moderate. The soldiers who have been in service for over 1 year hav e better explosive force, but they need more tolerance and aerobic exercises. Th e newly recruited need more exercise to raise tolerance to the hypoxic environme nt in plateau areas so as to shorten the adaption time to high altitude.

ObjectiveTo a nalyze the morphologic features of SMMC-7721 cannibalistic cells that induced by triazole Schiff base derivative(LH-37) in vitro. Methods The SMMC-7721 cells (1×10~4/ml)were cultured in the medium containing of 1×10~(-5) mol/L LH-37 for 24h,48h.The character of cells was detected by Papanicolaou and Wright′s Staining. Immunohistochemical method was used to observe the cleaved Caspase-3 positive cells. The ultrastructure of cannibalism cells was observed by JEM 100CX-II transmission electronic microscope. Results Microscopic analysis demonstrated the complete internalization of one cell within another. We noted that some cannibalistic cells in small aggregates appeared to be inside of large vacuoles, suggesting that they were internalized within a neighboring cell. The proportion of cannibalistic cells were increased after SMMC-7721 cells were cultured in the presence of LH-37 for 48 hours. The proportion of the cannibalistic cells in control and LH-37 group was 0.47% and 5.23% respectively . Many internalized cells were positive for cleaved caspase-3 staining . Ultrastructural analysis of engulfed cells from 24 hours exhibited evidence of live-cell internalization consistent with cannibalism, The most common fate for internalized cells was death after treatment with LH-37 for 48 hours, as evidenced by nuclear degradation and the eventual disappearance of some cells within the enveloping cell . Conclusion The data presented indicate that LH-37 can lead to an increase of cannibalism in human hepatocarcinoma cell in vitro.

Objective To investigate the effect of teaching mode innovation based on the tech-nology of digital orthopedic in orthopedic clinical teaching for eight-year program medical students. Methods 40 eight-year program medical students who took part in orthopedic clinical trainee in the 2015 school year were chosen and divided into two groups:traditional teaching group and digital tech-nology teaching group. The digital technology teaching group adopted a digital model of orthopedic technology, printing aids, use of auxiliary aids and simulate actual cases operative teaching while an-other group used traditional teaching. After the novitiate, questionnaire investigations were used to evaluate the effect of the orthopedic clinical teaching in both groups. At the same time an examination after the course was used to examine the teaching effect of the two groups, and SPSS 19.0 software was used to do chi-square test and t test to the result of the examination of both groups. Results Compared with the traditional teaching group students, the digital technology teaching group students more agreed with the new teaching mode for their interest in learning and hands-on ability bring positive influence (P<0.05), overall satisfaction of teaching method was significantly higher (P=0.03). The operation ex-amination result [(92.1±9.1) vs. (70.5±9.6)] and the comprehensive examination result (84.6±10.1) vs. (72.3±10.6)were more outstanding, the t test showed that the difference was statistically signifi-cant (P<0.05). Conclusion Teaching mode innovation based on the technology of digital orthopedic in eight-year program medical students has showed obvious advantages in orthopedic clinical teaching, which can stimulate students' interest in learning, improve the teaching effect and have broad applica-tion prospects in orthopedic clinical teaching.

Objective To evaluate the therapeutic effect of limb ischemic preconditioning (LIPC) by observing the changes of brain glucose metabolism using positron emission tomography (PET) and statistical parametric mapping (SPM). Methods 40 patients with severe stenotic or occlusion cerebral artery lesions were enrolled and randomized into LIPC group (n=20) and control group (n=20). Brain lesions and cerebral hemorrhagic lesions were excluded after magnetic resonance imaging. The glucose metabolism of patients was analyzed before and after treatment in two groups, respectively, using the methods of radioactivity ratio and SPM. Results There were 5 patients drop-out in the control group. Comparison of the glucose metabolism ratio of the impaired area to the opposite area: LIPC group improved better than the control group (P<0.01) while the control group aggravated heavier than LIPC group (P<0.05). Comparing the glucose metabolism of patients before and after treatment in two groups, respectively, by paired-t test, 1) Setting the glucose metabolism of patients increased after therapy: There were 9 areas activated in LIPC group, including frontal, parietal, temporal, occipital lobes, basal ganglia and thalamus, and the KE=927, while there were only 3 areas activated in the control group, including frontal, parietal and occipital lobes, and the KE=289. 2)Setting the glucose metabolism of patients decreased after therapy: There was no area activated in LIPC group, while there were 2 areas activated in the control group, including parietal and temporal lobes, and the KE=115. Conclusion The improvement of glucose metabolism was observed in cerebral cortex, basal ganglia and thalamus of the patients with severe stenotic or occlusion cerebral artery lesions after LIPC by PET and SPM.

Objective To observe the brain glucose metabolism after limb ischemic preconditioning (LIPC) for ischemic moyamoya disease with positron emission tomography (PET) and statistical parametric mapping (SPM). Methods 62 patients with ischemic moyamoya disease were enrolled and randomized into LIPC group (n=31) and control group (n=31). The glucose metabolism of patients was analyzed with PET before and after treatment in both groups, using the methods of radioactivity ratio and SPM. Results The glucose metabolism ratio improved more in the LIPC group than in the control group (P<0.01), and aggravated less than in the control group (P<0.001). As setting the glucose metabolism increased after treatment, there were 7 areas activated in LIPC group, including frontal, temporal and parietal lobes, and the KE=1121; while there were 5 areas activated in the control group, including frontal and parietal lobes, and the KE=292. As setting the glucose metabolism decreased after treatment, there was only frontal area activated in LIPC group, while there were 8 areas activated in the control group, including frontal, parietal, occipital lobes, and the KE=629. Conclusion LIPC may improve the brain glucose metabolism in patients with moyamoya disease, which can be observed with PET and SPM.

ObjectiveTo investigate the effect of β-adrenergic receptor(β2AR) stimulation on vascular smooth muscle cell apoptosis in physiological state and receptor overexpression model.Methodsβ2AR overexpression model was established by transgenic techniques. Hoechst 33342 staining as well as flow cytometer(FCM) detected were chosen to measure the incidence of vascular smooth muscle cell apoptosis.ResultsVascular smooth muscle cell exhibited significantly fewer viable cell rate when stimulated with β2AR agonist isoproteronol for 48 hours compared with control (P<0.01),while no difference at the time point of 24 hours. Much fewer viable rate detected by FCM and high apoptotic rate by Hoechst staining were observed when VSMCs overexpressing β2AR were stimulated with isoproteronol for 24 hours (P<0.01).ConclusionStimulation of physiological and overexpressing β2AR could induce apoptosis of vascular smooth muscle cell.

Objective To study the characteristics of cerebral glucose metabolism in adults with hypoxic-ischemic encephalopathy (HIE) using positron emission tomography (PET) and statistical parameter mapping (SPM), and evaluate the degree of the cerebral glucose metabolism damaged. Methods 26 HIE patients and 20 healthy controls received 18F-FDG PET imaging. The scope and degree of the brain radioactivity decrease were observed with visual analysis. The three-dimensional projection images and the KE value were obtained by SPM analysis. Results The glucose metabolic decrease in HIE was primarily bilaterally. The bilateral basal ganglia and thalamus metabolism decreased most obviously. The brain cortical lobes varied degrees of metabolic decrease according to the order from high to low was the frontal, occipital, parietal and temporal lobes. The basal ganglia and thalamus were taken as the important target area of the evaluation of damage degree, the degree of damage of HIE was divided into Level Ⅰ(mild), Level Ⅱ(moderate) and Level Ⅲ (severe) combined with cortex damage. Conclusion The basal ganglia and thalamus are the target areas of metabolic damage, the classification combined with brain cortex damage degree and scope can be used to guide the clinical treatment and prognosis evaluation.

10.3969/j.issn.2095-4344.2013.25.020