Objective:To study the expression of angiotensin-converting enzyme(ACE),extracellular signal-regulated kinase(ERK),and the changes of atrial fibrosis in patients with rheumatic heart disease(RHD) and atrial fibrillation(AF) treated with angiotensin-converting enzyme inhibitor(ACEI).Methods:Atrial tissues were obtained from the right appendage during open surgery in 35 patients with RHD.The mRNA of ACE and ERK2 were semi-qualified by reverse transcription-ploymerase chain reaction(RT-PCR) and normalized to the glyceraldehyde 3-phosphate dehydrogenase(GAPDH).Western blotting analysis was employed to examine the expressions of ACE and phosphorylated ERK(pERK).Atrial collagen volume fraction(CVF) was detected by Masson's stain.Results:The mRNA of ACE and ERK2 or the protein of ACE and pERK were significantly increased,and CVF was significantly increased in patients with chronic atrial fibrillation(CAF) compared with sinus rhythm group(SR)( P 0.05).Conclusion:The expressions of ACE,ERK2 and pERK increase,and fibrosis is more severe in RHD patients with CAF as compared with those with SR.Compared with CAF patients treated without ACEI,the expressions of ERK2 and pERK significantly decrease( P 0.05)in CAF patients treated with ACEI.This suggests that the increasing expression of ERK2 and pERK resulting from local renal angiotensin-converting enzyme system activation mediates the development of atrial fibrosis,and ACEI may contribute to lesser atrial fibrosis in RHD patients with AF.

Pulmonary hypertension (PH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation. PH progresses rapidly to right ventricular (RV) failure and even death without treatment. Cardiac magnetic resonance (CMR) is an accurate and reproducible tool for the assessment of RV morphology and function, which plays an important role in the prognosis of patients with PH. The aim of this study is to review the clinical application and research progress of CMR in evaluation of PH.

According to the sera aquaporin-4 antibody (AQP4), neuromyelitis optica (NMO) can be classified into two types as AQP4 antibody positive (AQP4+) and negative (AQP4-). However, the NMO patients with AQP4- are prone to delayed treatment, and may have a different pathogenesis compared to that in patients with AQP4+. Scientific researches and the clinical trials on NMO with AQP4- will deepen the understanding of NMO pathogenesis and help to make an early accurate diagnosis and rational therapy for NMO with AQP4-. This review aims to summarize the progress in clinic diagnosis for NMO patients with AQP4-.

Objective:To explore the main influencing factors for cardiopulmonary resuscitation (CPR ) in patients with perioperative cardiac arrest .Methods:A total of 168 patients ,who received surgery and suffered from cardiac arrest during perioperative period in our hospital from Jun 2012 to Jun 2014 ,were selected .According to recovery outcome of spontaneous circulation ,they were divided into success group (n=67) and failure group (n=101) .Case information were retrospectively analyzed in two groups ,including American Society of Anesthesiologists (ASA) class at hospitalization ,surgical sites ,monitor before cardiac arrest ,location when cardiac arrest occurred , dose of amiodarone ,volumes of bleeding and blood transfusion ,time of cardiac arrest during surgery ,CPR duration and timing etc .,and they were statistically analyzed between two groups .Results:There were significant difference in ASA class ,location when cardiac arrest occurred ,baseline ECG rhythm ,shock before cardiac arrest ,adrenaline dose ,CPR duration and timing between two groups ,P<0.05 or <0.01. Multifactor Logistic regression analysis in‐dicated that being outside operating room when cardiac arrest occurred (OR=9.72 ,95% CI=3.16~67.33) ,non-shockable rhythm (OR=8.33 ,95% CI=2.77~22.87) ,shock before cardiac arrest (OR=5.17 ,95% CI=3.23~16.13) ,adrenaline dose (OR=6.84 ,95% CI=2.61~44.75) ,CPR duration (OR=6.14 ,95% CI=1.77~17.21) and CPR timing >1min (OR=7.51 ,95% CI=2.57~41.93) were independent risk factors for prognosis of periop‐erative CPR , P< 0.05 or < 0.01. Conclusion:Being outside operating room when cardiac arrest occurs , non -shockable rhythm ,shock before cardiac arrest ,adrenaline dose ,CPR duration and CPR timing > 1min are inde‐pendent risk factors for prognosis of perioperative CPR . Cardioc arrest calls for instant CPR .

Objective To investigate the correlation between mechanical ventilation (MV) initiation time during cardiopulmonary resuscitation (CPR) and the prognosis of patients with in-hospital cardiac arrest (IHCA) in emergency . Methods Retrospective analysis of clinical records of patients with IHCA in emergency from January 2011 to April 2016 treated in Zhangye People's Hospital of Hexi University was performed. Patients with restoration of spontaneous circulation (ROSC) and were on MV with aged over 18 years were divided into early treated group (≤ 10 minutes) and later treated group (> 10 minutes) according to the initiation time of MV. Corneal reflex, pupillary reflex, pain-avoidance responses and motor response 24 hours after CPR, neurological function and cure rate of the two groups were analyzed. Results 210 patients were selected into our study including 130 males and 80 females (mean age: 60.24±13.17 years). There were no significant differences in gender, age, type of heart rate and etiological factor of cardiac arrest (CA) between the MV early stage group (124 cases) and the MV late stage group (86 cases). The restoration of corneal reflex, pupillary reflex, pain-avoidance responses, motor response and achievement ratio of CPR in early group were higher than those of later group (respectively, 59.68% vs. 31.40%, 59.68% vs. 31.40%, 54.84% vs. 24.42%, 54.84% vs. 24.42%, 70.16% vs. 51.16%, all P < 0.01); The D-dimer levels in the early group patients were significantly lower than those in the later group (μg/L: 478.39±57.21 vs. 510.05±62.83, P < 0.01). However, no statistical difference was observed between the two groups with respect to pH (7.24±0.72 vs.7.13±0.67, P > 0.05); The average hospitalized day of the early group was significantly shorter than that of the later group (days: 24.15±3.04 vs. 30.28±4.17, P < 0.01); Besides, the early group showed a higher survival rate at discharge and had more cases with neurologic level of grade 1-2 than those of the later group (Respectively, 41.94% vs. 26.74%, P < 0.05; 44.35% vs. 15.12%, P < 0.01). Conclusion Initiation MV on IHCA patients in the early stage of CPR (≤ 10 minutes) could help improve the hypoxic condition and prognosis of neurological function, and increase the achievement ratio of CPR.

Objective To understand the current situation of multidrug-resistant organism (MDRO)infection in hospitalized patients in a tertiary first-class hospital,as well as efficacy of bundle intervention measures on preven-tion and control of infection. Methods Hospitalized patients who were infected with MDROs in this hospital during 2012-2014 were monitored and conducted bundle intervention. Results In 2012-2014,a total of 1909 MDRO strains were isolated. The isolation rates of MDROs in 2012-2014 were 30.69% ,31 .04% ,and 29.40% respec-tively,bedside intervention rates were 81 .02% ,92.05% ,and 94.23% respectively,implementation rates of clinical isolation were 69.97% ,82.98% ,and 93.04% respectively;MDRO isolation rates during 2012-2014 were not sig-nificantly different(P>0.05);bedside intervention rates and implementation rates of clinical isolation were both sig-nificantly different(both P<0.05). The top 3 isolated MDROs in 2012-2014 were extended-spectrumβ-lactamases (ESBLs)-producing Escherichia coli,multidrug-resistant Acinetobacter baumannii,and ESBLs-producing Klebsiel-lapneumoniae. Conclusion Bundle intervention measures,such as multi-department collaboration and strengthened on-site supervision,can promote more standardized management of healthcare-associated infection,enhance the im-plementation rate of clinical isolation,and effectively prevent and control the spread of MDRO in hospital.

As an important part of medical supplies, the logistics management of high-value medical consumables becomes a key link in modern hospital administration. Compare between the management of high-value medical consumables and modern supply chain management. Based on 4R theory, discusses and analyses the management of high-value medical consumables in Fuwai hospital. By means of 4R theory, modern supply chain management has been optimized for the actual consumable management. And found out a effective method to resolve bullwhip effect caused by the limitations of high-value medical consumables. This research demonstrate modern hospital want to win the competitive initiative only by the improvement of material flow management level.

Objective To evaluate the role of PI3K-Akt-HIF-1α signaling pathway in dexmedetomidine-induced reduction of damage to the unventilated lung during one-lung ventilation (OLV) in rats.Methods Forty adult male Sprague-Dawley rats,weighing 250-350 g,were randomly divided into 4 groups (n=10 each) using a random number table:two-lung ventilation TLV) group,OLV + normal saline group (group OLV),OLV + dexmedetomidine group (group D),and OLV + dexmedetomidine +LY294002 group (group DL).Bilateral lungs were ventilated for 2.5 h in group TLV,and the right lung was ventilated for 2 h followed by 0.5 h TLV in the other groups.The rats were sacrificed,the left lung was removed for determination of wet to dry lung weight ratio (W/D ratio),and expression of phosphorylated Akt (p-Akt) and hypoxia-inducible factor-1 alpha (HIF-1α) (by Western blot).Results Compared with group TLV,W/D ratio was significantly increased,the expression of p-Akt was down-regulated,and the expression of HIF-1α was up-regulated in the other three groups (P＜0.05).Compared with group OLV,W/D ratio was significantly decreased,and the expression of p-Akt and HIF-lα was up-regulated in D and DL groups (P＜0.05).Compared with group DL,W/D ratio was significantly decreased,and the expression of p-Akt and HIF-1α was up-regulated in group D (P＜0.05).Conclusion PI3K-Akt-HIF-1α signaling pathway is involved in dexmedetomidine-induced reduction of damage to the unventilated lung during OLV in rats.

Objective To detect the effect ofXuebijing injection on the serum soluble CD40 ligand (soluble CD40 ligand, sCD40L), lipoprotein associated phospholipase A2 (lipoprotein-phospholipase A2, Lp-PLA2) of patients with acute coronary syndrome (ACS).Methods A total of 120 patients with ACS were randomized divided into the control group and treatment group, 60 in each group.The control group received the routine treatment of Western medicine, and the treatment group receivedXuebijing injectionbased on the intervention of control group. Both groups were treated for 2 weeks. ELISA method was used to detect serum sCD40L, Lp-PLA and IL-6, TNF-α and CRP.Results After treatment, the serum sCD40L(320.62 ± 35.81 pg/Lvs. 401.70 ± 4.84 pg/L, t=10.435), Lp-PLA2 (203.62 ± 33.13μg/L vs. 296.45 ± 4.422μg/L,t=12.831) level was significantly lower than those in the control group (P<0.01); The serum CRP (3.10 ± 2.00 mg/Lvs.4.74 ± 2.04 mg/L,t=4.006), IL-6 (2.10 ± 1.20 pg/Lvs.3.14 ± 1.40 pg/L,t=3.781), TNF (2.81 ± 1.50 pg/Lvs. 3.70 ± 1.70 pg/L,t=3.075) level was significantly lower than thosein the control group (P<0.01 orP<0.05). Compared with the control group, the effect rate (68.3%vs. 50.0%,χ2=4.174) of the treatment group was significantly higher (P=0.041).ConclusionXuebijing injection can improve the therapeutic effectof ACS patients, and reduce CD40L, Lp-PLA2 levels.

OBJECTIVE: To prepare fumeisong cream and establish its quality control method. METHODS: Ingredients including carbamide, triamcinolone acetonide acetate, camphor, and laurocapram were mixed in an oil-in-water matrix for preparation of fumeisong cream. HPLC was adopted to determine the content of triamcinolone acetonide in the cream. RESULTS: The prepared cream was white in color, with test items all in line with specifications stipulated in 2005 version of China Pharmacopoeia. The linearity concentration range of triamcinolone acetonide was 2.06～20.6 ?g?mL-1(r=0.999 6) and the average recovery rate was 99.6% (RSD=1.0%,n=9). CONCLUSION: The cream is simple and feasible in preparation techniques, and its quality is stable and controllable.