Objective　To study the relation between myocardia l changes and left ventricular function in preoperative patients with combined m itral diseases provide theoretical basis for clinical therapy and evaluate the effects of treatment. Methods　A total of patients with combined mitral lesions were selected randomly for study. The cases were divided into tw o groups according to the degree of ultrastructural damage of the myocardium bef ore aortic occlusion in mitral valve replacement (Flameny cla ssification). The preoperative pulmonary artery catheterization(Swan-Ganz cathe ter), color Doppler echocardiography, roentgenologic measurement of heart size, preoperative clinical data and postoperative follow-up data were collected for analysis. Results　The results showed that myocardial lesion in mitral disease had intimate correlation with the cardiac enlargement, especial c orrelated with left ventricular enlargement and cardiac pumping. Conclus ion　Results suggest that the myocardial lesions in mitral valvular dise ases mainly involved the process of rheumatism and reflected in the disturbance of left ventricular function. Operation should be performed before the appeare nce of non-reversible myocardium injury in patients with rheumatic mitral va lvul ar diseases.

Nowadays doctor-patient conflicts have benn a focus problem,which the important reason is "trust crisis"between doctors and patients.Doctor-patient trust is the guarantee of medical profession.It is the key to build binding mechanism of sincerity and trust in hospitals,promote humanistic accomplishment and medical ethics accomplishment of medical professinal.

Objective To detect neurotransmitters function in the brain and the brain functional index of outpatients with methadone maintenance treatment,and understand the change features of brain function.Methods Collect brain electrical power signals were collected from 58 outpatients with methadone maintenance treatment (MMT) and 44 healthy adults,and the correlations between the power of the neurotransmitters and the brain functional status were analyzed.Results (1) In MMT group,all neurotransmitters were lower generally than those in the control group,and the differences of GABA ((17.73±3.54) μV2 vs.(121.48±44.64) iμV2,P＜0.01),Glu ((42.18±12.84) μV2 vs.(105.31 ± 34.95) μV2,P＜0.05) were significant.(2) The relative powers of GABA ((17.10±51.72) μV2 vs.(78.67± 10.93) μV2,P＜0.001) and Glu((30.48±21.61) μV2 vs.(69.23±42.26) μV2,P＜0.001) reduced significantly,while 5-HT((297.18±31.54) μ V2 vs.(280.18±31.54) μV2,P＜0.01),ACh ((235.08±37.72) μV2 vs.(217.23±40.60)μV2,P＜0.05),NE((164.11±33.05) μV2 vs (146.39±30.80) μV2,P ＜0.01),DA((98.87±22.48) μV2 vs.(91.49±21.04)μV2,P＜0.05) rised significantly in MMT group.(3)The global power was lower((1012.01± 195.09)μV2 Vs.(1775.94±458.99) μV2,P＜0.01),and the excitement-inhibition index(2.19± 1.46 vs.0.99±0.47,P＜0.001) and the relative entropy((89.45±9.71) ％ vs.(75.48±9.97) ％,P ＜0.01)were higher than those in the controls.(4) In MMT group,there were positive correlation between all neurotransmitters and global power,as well as that between Glu and excitement-inhibition index (r=0.264,P＜0.05),NE and Vasomotor index(r=0.269,P＜0.05),but negative correlation between relative entropy and 5-HT(r=-0.276,P＜0.05) as well as DA(r=-0.375,P＜0.01)significantly.Conclusion The brain function of outpatients with MMT are lower than the normal significantly,and there are clearly imbalance between the excitement and inhibition among the brain neurotransmitters.

OBJECTIVE:To promote the working efficiency of hospital prescription evaluation and improve pharmacists profes-sional quality through developmenting electronic prescription evaluation system (EPES) for outpatient department used by taking full advantage of large amount of information of electronic prescription. METHODS:By using system structure of Client/Server, Web Service middleware,programming tool of PowerBuilder and database technique of Oracle and sharing Hospital information sys-tem data,EPES was designed and applied,which could collect prescription information and generate summary form automatically after artificial prescription evaluation. RESULTS & CONCLUSIONS:Integration of outpatient electronic medical records,historical prescriptions and medical test results query system make the EPES carry comprehensive information which could make up for disad-vantages of paper prescription form in the aspect of obtaining outpatient medical records,historical prescriptions or medical test re-sults. EPES can accomplish general and special prescription evaluation and also pledges the equity and justness of process by ran-dom sampling. The operation of the system could improve the efficiency from taking 24-36 h in paper prescription form to 4-6 h to complete general prescription evaluation,which also improves professional quality of pharmacists by intensive training.

Objective To analyze the biological characteristics and morphologic features between the mouse models using MDA-MB-231 cells established by injecting tumor cell suspension or implanting tumor tissues. Methods Twenty BALB/c mice were randomly divided into two groups,with 10 in each group.The orthotopic models of breast cancer were established by injection of tumor cell suspension or implantation of tumor tissues in the fat pad of right second breast in the nude mice of the two groups,respectively.The time of tumor formation,success rate,tumor growth rate,shape,central tumor necrosis,blood vessel distribution and tumor ulceration were compared between the two groups of models.The histological features of the tumors were also observed. Results There were no significant difference in the success rate between the two methods.In the group of tumor tissues implantation,the tumors formed in an earlier time with various shape configurations,and they were hypovascular and vulnerable to central necrosis with the resultant superficial ulcerations.However,in the group with injection of tumor cell suspension,the tumors formed later with a regular shape,and the superficial ulceration was rare and not vulnerable to central tumoral necrosis since the tumors were abundant in blood vessels resulting in adequate nourishment.There were no significant difference in the pathological findings between the two groups. Conclusion The nude mouse models of breast cancer can be successfully established by both tumor tissues implantation and tumor cell suspension injection,with identical biological characteristics and fairly different morphological features.The investigators are well advised to choose the more appropriate one according to the purpose of the experiments.

Purpose:To study the changes of t-PA ?u-PA expression and fibrinolysis molecular mark ers in patients with gastric or intestinal cancer in order to elucidate their cl inical significance. Methods:The plasma levels of t-PA ?u-PA ?u-PAR and PAP were measured by ELISA . Gen e transcription of t-PA?u-PA mRNA were detected by Real-time RT-PCR. Results:The plasma levels of u-PA?u-PAR and PAP were elevated in gastric or intestina l cancer patients ,while u-PA was markedly elevated in patients with local infi ltration?lymph node involvement or distal metastasis. u-PA mRNA was higher and t-PA was lower in gastric or intestinal cancer compared to normal tissue. Conclusions:Hyperfibrinolysis was an important factor related with m etastasis potential of gastric or intestinal cancer. t-PA may be a character of well differentiated tissue.

Purpose:To observe the therapeutic effect of gemcitabine combined with 5-FU for the treatment of advanced cholangiocarcinoma. Methods:21 patients were given gemcitabine and 5-FU intravenously. Results:There was no complete response .The partial response rate was 23.8% and SD,38.1%.12 patients(57.14%) had amelioration of pain and improvement in quality of life.The toxicity was low and tolerable. Conclusions:Gemcitabine combined with 5-FU was an effective and safe regimen for treating advanced cholangiocarcinoma and worthy of further evaluation.

Objective In a randomized double blind study, we have compared the analgesic efficacy and safety of PCA with buprenorphine and PCA with morphine after abdominal hysterectomy. Methods One hundred and fifty-four patients aged 25-55 yr undergoing abdominal hysterectomy were included in this study. Patients with severe cardiac, cerebral, hepatic and renal disease and those who had recently taken monoamine oxidase inhibitor were excluded. Anesthesia was induced with propofol 1.5-2.0 mg?kg-1 and intubation was facilitated with succinylcholine 1.5 mg?kg-1 or vecuronium 0.1 mg?kg-1 . Anesthesia was maintained with inhalation of l%-2% isoflurane and 50% nitrous oxide in oxygen supplemented with intermittent iv boluses of vecuronium 1-2 mg, fentanyl 2?g?kg-1 and droperidol 1-2 mg. The patients were randomly divided into 2 groups: 1 buprenorphine group (B, n = 77 ) and 2 morphine group (M, n = 77) . In group B, patients received PCA with buprenorphine (bolus dose 0.03 mg, lockout interval 14 min, 24 h dose limit 1.2 mg); in group M patients received PCA with morphine (bolus dose 1 mg, lockout interval 5 min, 24 h dose limit 40 mg). Intensity of pain was assessed using VAS with 0 representing no pain and 10 representing the worst pain. Pain intensity difference before and after PCA and pain relief (PAR) (0 = not relieved, 4 = completely relieved) , patient satisfaction and adverse effects were recorded. Results The two groups were comparable with regard to age, body weight, duration of operation, the time when postoperative pain started and PCA was commenced, and the intensity of postoperative pain. There was no significant difference in pain intensity before and after PCA and PAR between the two groups. The incidence of nausea and vomiting was significantly higher in group B than in group M ( P

Objective To analyze the correlation between fluid equilibrium and oxygen index in patients at early stage (within 2 weeks) of severe acutepancreatitis (SAP),and to discuss the effects of fluid equilibrium after resuscitation on the prognosis.Methods A clinical study was conducted.Ninety-seven patients with SAP admitted into Shengjing Hospital of China Medical University directly or transferred into intensive care unit (ICU) in 24 hours after admission between March 201 1 to October 2013 were studied.Finally,65 patients were enrolled in statistical analysis,and those with termination of treatment prematurely were excluded.The patients received treatment protocol formulated by the same physician in ICU.Patients were divided into improved group and death group according to the outcome.The differences in fluid equilibrium on 1,2,3,7,14 days after admission of ICU between the two groups were compared.The correlation between fluid equilibrium and oxygen index was analyzed with curve fitting.Results Among 65 patients enrolled,53 of them were improved after intensive care and were transferred into ordinary wards.However,12 patients died in ICU.Patients in the improved group showed delayed positive fluid equilibrium,and some patients even showed negative fluid equilibrium.Patients in death group needed more fluid to achieve fluid equilibrium.There was a significant difference in the need of fluid to reach an equilibrium between improved group and death group [1 day:1 814.5 (905.2,2 152.8) vs.3 891.0 (2 524.2,5 714.5),Z=-3.303,P=0.001; 2 days:2 469.0 (1 456.0,3 696.0) vs.6 498.0(4 617.8,8 763.5),Z=-4.431,P＜0.001 ; 3 days:3 234.0 (1 098.0,4 295.5) vs.9 533.5 (6 748.8,10 689.0),Z=-4.684,P＜0.001 ; 7 days:3 234.0 (1 033.0,5 162.0) vs.13 986.5 (8 045.8,14 518.0),Z=-4.718,P＜0.001 ; 14 days:3 234.0 (978.5,4 924.0) vs.13 436.5 (8 045.8,14 518.0),Z=-4.769,P＜0.001].There was no correlation between fluid equilibrium and oxygen index in improved patients within 3 days of ICU admission (R 2=0.000,P=0.827),and it fit the logistic curve in a relatively low level after 3 days of ICU admission (R 2=0.036,P＜0.001).Conclusions Early fluid resuscitation could help maintain hemodynamics stability in SAP patients.Those SAP patients who showed a negative equilibrium in early stage showed a better prognosis,and the fluid equilibrium and oxygen index in improved patients fit the logistic curve after 3 days of ICU admission.

Objective To discuss the neuropsychological mechanism of executive control for methadone maintenance patients(MMP).Methods Using the event-related potentials (ERPs) technique to reveal the time course of information processes with high temporal resolution,and exam the function of attention monitoring and response inhibition in heroin-dependent MMP.Results (l) The behavioral results: there were significant withinsubjects Stroop interference effects for the MMP and control groups (reaction time:control group' s congruent condition(766.57±75.64) ms,incongruent condition(879.52±62.31) ms,MMP group' s congruent condition (821.89±64.44) ms,incongruent condition (906.29 ± 69.46) ms,P＜ 0.001 ; error rate: control group' s congruent condition (4.15± 2.92) ％,incongruent condition (8.70 ± 6.12) ％,P＜ 0.001,MMP group' s congruent condition (12.07 ±10.80) ％,incongruent condition (16.60±12.43)％,P＜0.01).(2)ERPs data showed that MMP demonstrated significantly smaller incongruent-N2/N450/SP amplitudes than controls,and all disappearing incongruent effects in N2,N450 and SP,comparing statistically significant incongruent effects for controls in N2,N450 and SP.In MMP group,the amplitudes of N2 and N450 incongruent condition (N2 (1.40± 2.91) μV、N450 (1.29 ± 0.55) μV) were bigger than congruent condition amplitudes(N2(0.77±3.61) μV 、N450(0.83± 1.07) μV,P＜0.05),but the amplitude of SP (0.37±3.58)μV was smaller than congruent condition(1.53±3.05) μV,P＜0.001 ;in control group,the amplitudes of N2 and N450 incongruent condition((-0.30±3.45) μV,N450(1.77± 1.55)tμV) were smaller than congruent condition (N2(1.10±3.64) μV,P＜0.001； N450(2.37±2.12) μV,P＜0.05),the amplitude of SP ((1.93±1.65) μV) was bigger than congruent condition((0.98±2.02)μV,P＜0.01).Conclusion There are impaired executive control functions during the conflict monitoring process and the conflict resolution process for MMP.These results provide the neural electrophysiological evidence to explain relapse behaviors in methadone maintenance patients.