Objective To investigate and analyze the efficacy of intravenous levosimendan in the treatment of acute cardiac failure after cardiac surgery. Methods The study of the 80 cases of acute heart failure in patients undergoing cardiac surgery after treatment in March 2014 to March 2017, the patients were monitored in the treatment before and after treatment of 24 h heart rate, left ventricular ejection fraction, mean arterial pressure and central venous pressure and other related indicators. Results Of all patients, 58 survived after treatment, and 22 died during or after treatment. Compared with before treatment, after treatment of 24 h in left ventricular ejection fraction in patients, mean arterial pressure, central venous and changes in heart rate were significantly improved, data between the two groups had significant difference compared with statistical significance(P<0.05). In 8 patients, transient blood pressure reduction occurred during treatment, but symptoms disappeared after taking appropriate measures, and other patients had no more severe adverse reactions. Conclusion According to the method of intravenous levosimendan in treatment of acute heart failure in patients undergoing cardiac surgery after treatment can make the patient's cardiac function improved, has a significant effect on the prognosis of patients, should have a relatively high value.

Objective To study the expression and clinical significance of survivin in acute leukemia. Methods By using semi-quantitative RT-PCR technique, survivin gene expression was detected in 43 acute leukemia(AL). Results Survivin gene expression rate in the cells of AL patients at diagnosis was 69.77%(30/43). Survivin mRNA expression rate in both 18 acute lymphocytic leukemia (ALL) and 25 acute nonlymphocytic leukemia(ANLL) (72.22% and 68.0% respectively) was signficantly higher than that in control group (33.33%,P0.05). Conclusions Survivin gene was highly expressed in AL patients and could be a potential target for treatment of AL.

Objective To investigate the clinical value of combined detection of the serum levels of CA125,CA72-4 and tumor specific growth factor(TSGF)in the diagnosis of ovary cancer and the curative effect.Methods Serum levels of CA125,CA72-4 and TSGF in 68 patients with ovary cancer,53 patients with benign ovary rumor and 50 normal controls were measured by chemiluminescent immunoassay(CLIA)and chemical colorimetry.Results and clinical data were statisticaly analyzed.Results The levels of CA125,CA72-4 and TSGF in ovary cancer group were higher than that in the benign ovarian tumor group and healthy controls(all P ＜0.01).When use three tumor markers united detection,sensitivity,specificity and accuracy were 91.2％,83.0％ and 87.4％ respectively.The sensitivity and accuracy was higher than any single detection.The specificity with single CA125 testing was consistently.The levels of CA125,CA72-4 and TSGF in patients with ovary cancer were significantly different after surgical treatment for five days(all P ＜0.05).Conclusion The combined detection of the three markers may increase the positive rate in the early diagnosis of ovarian cancer,and help to differentiate the benign and malignant ovarian tumor,but also is valuable to observe the curative rate and postoperative monitor of the ovary cancer.

Objective To study the prevalence and characteristics of gastroesophageal reflux disease (GERD) in patients with idiopathic pulmonary fibrosis(IPF).Methods A total of 48 patients with diffuse parenchymal lung disease(DPLD) including 25 IPF and 23 other DPLD were enrolled from Department of Respiratory Disease in the First Affiliated Hospital of China Medical University.All patients were subjected to 24-hour esophageal pH monitoring.Pulmonary function test and HRCT of lung were performed at the same time.Results The prevalence of GERD in IPF patients was 64.0％,which was significantly higher than that in other DPLD patients.DeMeester scores were significantly higher in IPF patients than those in non-IPF group[(22.8 ± 21.5) score vs (15.7 ± 14.0) score respectively P ＜ 0.05].Numbers of reflux longer than 5 minutes [(3.8 ± 4.1) time vs (2.1 ± 2.1) time respectively) and reflux index (1.8 ± 1.7 vs 1.3 ± 1.2) in IPF group were higher than those in non-IPF group,yet without statistical significance.Patients with IPF had significantly higher values of following parameters than those in non-IPF patients including percentage of total reflux time(pH ＜ 4.0) (9.2 ± 5.1) ％,percentage of upright reflux time (8.5 ± 5.2) ％,percentage of supine reflux time (10.8 ± 10.7) ％,numbers of reflux (54.2 ± 22.7) time,numbers of regurgitation longer than 5 minutes (6.3 ± 4.2) time,thelongest reflux time (14.5 ± 15.3) min,reflux index 2.5 ± 1.7 and DeMeester scores (34.9 ± 20.3) time (P ＜ 0.05).DeMeester score was positively correlated with gastroesophageal reflux diseases questionnaire (GerdQ) score (r =0.667,P ＜ 0.01).The prevalence of typical GERD sympotoms in the IPF-GERD patients was higher (heartburn 7/16,regurgitation 6/16) than that in IPF patients without GERD (heartburn 2/9,regurgitation 1/9).Conclusion Patients with IPF have a high prevalence of GERD,but usually without typical GERD symptoms.In the hospitals 24-hour esophageal pH monitoring not available,GerdQ can be used to identify GERD in IPF patients.

AIM:To investigate COX-2 and iNOS protein contents and their interaction in vascular endothelium injury of rats with deficiency of vital energy or qi stagnation,and the prevetion and treatment of Tongxinluo.METHODS:The model of vascular endothelium injury of rats with deficiency of vital energy or qi stagnation was established by using high L-Methionine,with load-carrying swimming or being fastened respectively.Western blotting was used to analyze protein contents of COX-2 and iNOS,co-immunoprecipitation and laser confocal microscopy were used to analyze the interaction between COX-2 and iNOS.Optical microscope and electronic microscope were used to evaluate pathological changes in vascular endothelium.RESULTS:The protein contents of COX-2 and iNOS,and their interaction increased significantly in deficiency of vital energy group and qi stagnation group,in accord with injury of vascular endothelium.Compared with deficiency of vital energy group and qi stagnation group respectively,their protein contents decreased and their interaction was weakened in Tongxinluo groups.CONCLUSION:When protein contents of COX-2 and iNOS increase and their interaction enhance after vascular endothelium injury of rats with deficiency of vital energy or qi stagnation,initiate exacerbations,Tongxinluo could attenuate the alterations and protect vascular endothelium from injury.

Objective To explore CTA characteristics of diabetic lower extremities arterial disease (LEAD) with different Fontaine stage.Methods Data of 100 patients clinically diagnosed as diabetic LEAD and underwent lower limbs arterial CTA were analyzed retrospectively.The patients were classified into grade Ⅰ-Ⅳ according to Fontaine classifications.Lower extremities arteries were graded according to CTA.Stenosis degree of lower extremity arteries in different Fontaine stages were analyzed.Results The grades of lower extremity arteries stenosis in different Fontaine stages had statistically significant difference (x2 =186.24,P＜0.001).There had statistically significant difference of stenosis degree in different lower extremity arterial levels among different Fontaine stages (superior genicular artery:x2 =69.24,P＜0.001;inferior genicular artery:x2 =111.59,P＜0.001;dorsalis pedis and arteriae plantaris:x2 =94.15,P＜0.001).Grades of stenosis between superior genicular arteries and inferior genicular arteries,superior genicular arteries and dorsalis pedis and arteriae plantaris had statistically significant differences (Z=12.59,P＜0.001;Z=10.47,P＜0.001).There was statistically significant difference of stenosis grades between inferior genicular artery and dorsalis pedis and arteriae plantaris (Z=12.66,P＜0.001).Occluded inferior genicular arteries usually associated with collateral vessels.Conclusion CTA can reflect the clinical stages of LEAD,which is the ideal method in diagnosing of diabetic LEAD.

Objective To investigate the value of dynamic contrast-enhanced quantitative parameters of pancreatic cancer at 3.0T MR.Methods 27 patients with pathologically proved pancreatic cancers were underwent DCE-MR at a 3.0 T scanner.AToft with Vp model was used to quantify K trans ,k ep ,Ve and Vp in the pancreatic cancer and normal pancreatic tissues.All parameters among different tissues were analyzed and compared by SPSS1 7.0.Results The K trans 、k ep 、Ve 、Vp values of pancreatic cancer were(0.303± 0.321)min,(1.387±1.486)min,(25.07±10.98)%and(3.420±4.692)% respectively ,while those values of normal pancreatic tis-sue were (1.235±0.777)min,(9.277 ± 7.996 )min,(1 7.89 ± 8.882 )%,and(7.1 96 ± 6.704)%,respectively.The differences be-tween the four parameters of pancreatic cancer and normal pancreatic tissue were statistically significant(F =33.188,25.414,6.984, 5.78,P <0.05).Conclusion Quantitative parameters of DCE-MRI accurately reflect changes in tumor blood perfusion and microcir-culation,they may be helpful to differentiate the atypical lesion.

Objectives To compare total laparoscopic gastrectomy with intracorporeal hand-sewn Gl reconstruction and laparoscopy-assisted gastrectomy for gastric cancer. Methods Between July 2009 and July 2010, 21 patients of gastric cancer underwent total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn reconstruction and 28 did laparoscopy-assisted D2 radical gastrectomy in Xijing Hospital of Digestive Diseases. All patients were operated on by an experienced surgeon. Patient demographics, TNM stage, location of tumor, the intraoperative and postoperative details of the two groups were compared. Results In the 21 patients undergoing total laparoscopic gastrectomy, there were 15 of distal gastrectomy and 6 of total gastrectomy, compared with 21 and 7 in laparoscopy-assisted group. In total laparoscopic group, intracorporeal hand-sewn technique was used for gastro-jejunal and jejuno-jejunal (J-J)anastomosis, and 25 mm circular stapler was used for esophago-jejunal anastomosis. The operation time was significant longer in total laparoscopic group than in laparoscopy-assisted group of (279 ± 65 ) min vs.(232 ±40) min (P ＜ 0.05 ). No significant difference was observed between the two groups in proximal margin [(5.7 ± 1.5 )cm vs. (5.1 ± 1.4) cm, P ＞ 0.05] and distal margin [( 3.1 ± 0.9 )cm vs. ( 2.9 ±0.9) cm,P ＞0.05]. The iv narcotic use in laparoscopy-assisted group was 1.8 d but it was not used in total laparoscopic group. The first passing flatus was on day 3 in total laparoscopic group compared with 4.8 d in laparoscopy-assisted group. Both groups had 2 postoperative early complications, one intra-abdominal infection and one lung infection in total laparoscopic group compared with one wound infection and one lung infection in laparoscopy-assisted group. There was no anastomosis-related complications after 4 months of follow-up. Conclusions The operation time and postoperative early complication was acceptable for selected patients treated by total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn GI tract reconstruction in hands of experienced laparoscopic surgeon.

Objective To investigate the age-related pattern of normal skull bone marrow with 3. 0 T MR T1WI. Methods Cranial MR T1WI images which were defined to be normal were retrospectively reviewed in 360 cases. Patients with known diffuse bone marrow disease, focal lesions, history of radiation treatment or steroid therapy were excluded, while patients whose cranial MRI and follow-up visits were all normal were included in this study. All the subjects were divided into 7 groups according to the age: < 1, 1--2,3--5, 6--14, 15--29, 30--49, >50 years group. Mid- and para- sagittal T1WI images were used to be analyzed and the type of cranial bone marrow was classified according to the thickness of diploe and the pattern of the signal characteristics. Statistical analysis was conducted to reveal the relationship between the age and the type. Results The normal skull bone marrow could be divided into four types as follows: (1) Type- Ⅰ : 115 cases, 47 of which appeared type- Ⅰ a and the mean thickness was ( 1.24±0. 31 ) mm; 68 of which appeared type- Ⅰ b and the mean thickness was ( 1.76 ± 0. 37 ) mm. Type- Ⅱ : 57 cases and the mean thickness was (2.78 ±0.69) mm. Type-Ⅲ: 148 cases, 18 of which appeared type-Ⅲ a and the mean thickness was (2. 33±0. 65) mm; 88 of which appeared type-Ⅲ b and the mean thickness was (4. 01 ± 0. 86) mm; 42 of which appeared type-Ⅲ c and the mean thickness was (4. 31±0. 73) mm. Type-Ⅳ: 40 cases, 25 of which appeared type-Ⅳ a and the mean thickness was (5. 17 ± 1.02) mm; 15 of which appeared type-Ⅳ b and the mean thickness was (5.85±1.45) mm. (2) <1 year group: 40 cases, 20 of which appeared type- Ⅰ a, 20 type- Ⅰ b and the mean thickness of this group was ( 1.47 ± 0. 42 ) mm. 1-- 2 years group: 40 cases, 16 of which appeared type- Ⅰ a, 18 type- Ⅰ b, 6 type- Ⅱ and the mean thickness of this group was ( 1.68±0. 52) mm. 3--5 years group: 40 cases, 8 of which appeared type- Ⅰ a, 18 type-Ⅰb, 14 type-Ⅱ and the mean thickness of this group was (1.84±0.73) mm. 6--14 years group: 60 cases, 3 of which appeared type- Ⅰ a, 12 type- Ⅰ b, 27 type-Ⅱ , 12 type-Ⅲb, 6 type-Ⅲc, and the mean thickness of this group was (2.92±1. 00) mm. 15--29 years group: 60 cases, 7 of which appeared type-Ⅱ , 5 type-ma, 27 type-Ⅲb, 15 type-Ⅲc, 6 type-Ⅳa and the mean thickness of this group was (3.95 ± 0.97) mm. 30---49 years group: 60 cases, 3 of which appeared type-Ⅱ , 7 type-Ⅲa, 29 type-Ⅲb, 15 type-Ⅲc, 3 type-Ⅳa and 3 type-Ⅳb and the mean thickness of this group was (4. 30 ± 1.35) mm. ≥50 years group: 60 cases, 6 of which appeared type-Ⅲ a, 20 type-Ⅲb, 6 type-Ⅲc, 16 type-Ⅳa and 12 type-Ⅳb and the mean thickness of this group was (4.51 ± 1.40) mm. (3) There is a linear relationship between ages and types that is revealed by chi-square test (x2 = 266. 36, P < 0. 01 ). Conclusion There is characteristic in the distribution of normal skull bone marrow with age growing. And skull bone marrow transforms gradually from type- Ⅰ to Ⅳ with aging.

Objective By analyzing the cesarean delivery rate (CDR) and the indications of cesarean section in Jiangsu Province from 2012 to 2014, to find the strategy to reduce CDR.Methods Data of 40 hospitals whose number of delivery was over 2 400 per year from the database of the Quality Control Center of Gynecology and Obstetrics of Jiangsu Province from 2012 to 2014 were selected.The cohort was divided into two groups, one was specialized hospital including 11 maternal and child health hospitals and the other included 29 general hospitals.After analyzing the current status of cesarean section of the whole province, the average CDR and the distribution of the first indications of cesarean section in two groups were compared using Chi-square test.Results The average CDRs at year 2012, 2013 and 2014 were 53.8％(96 347/178 970), 51.8％ (97 509/188 142) and 48.8％(106 323/217 877), which had a trend of decrease (x2=1 026.2, P ＜ 0.01).CDR without medical indications for each year were 15.7％ (28 098/178 970), 15.5％ (29 162/188 142) and 12.8％ (27 888/217 877).The rate had decreased apparently from both 2012 and 2013 to 2014 (x2=217.6, P ＜ 0.01;x2=341.3, P ＜ 0.01).The CDRs of specialized hospitals for year 2012, 2013 and 2014 were 51.2％ (45 496/ 88 916), 50.6％ (45 853/90 607) and 49％ (55 404/113 105), while the CDRs of general hospitals for each year were 56.6％(50 851/90 054), 53.0％(51 656/97 535) and 48.6％(50 919/104 772).Both showed significant decreasing trend (x2=105.8 and 1 215.7, both P ＜ 0.01).The average CDR of general hospitals was obviously higher than that of specialized hospitals in 2012 and 2013 (x2=505.6 and 104.3, both P ＜ 0.01).However, the difference disappeared in 2014 (x2=3.2, P ＞ 0.05).The three main first indications of cesarean section were associated and postoperative pregnancy complications, and no medical indications.Interestingly, from 2012 to 2014, the CDR for scarred uterus in specialized hospitals raised from 5.4％ to 20.3％, and that in general hospitals increased from 6.7％ to 21.6％, which became the first.Conclusions The average CDR in Jiangsu Province tends to decrease each year, so does the CDR without medical indications.The first indication of cesarean section is associated or postoperative pregnancy complications, while scarred uterus becomes the most common in cesarean section.