0.05) were found in ejection fraction (EF), fractional shortening of left ventricle (DD), blood flow velocity through aortic valve, blood flow velocity through pulmonary valve, E peak velocity of mitral valve, left atrial end-systolic anterior-posterior diameter, left ventricular end-systolic anterior-posterior diameter, left ventricular end-systolic left-right diameter and left ventricular end-diastolic left-right diameter after 2-4 hours of +Gz exposure. A peak velocity in mitral valve slightly increased (P

Objective To investigate the effect of dexmedetomidine on postoperative renal function of patients with rheumatic heart disease following valvular heart surgery. Methods Fifty patients following valvular heart surgery were randomized into experimental group and control group,with 25 cases in each group. The patients in experimental group receiveddexmedetomidine 0.5 μg/kg infusion 15min before induction, and then 0.5 μg/(kg·h) infused to the end of surgery, while those in control group received the same amount of saline in the same way. Blood from central venous was collected before surgery, at the end of surgery, 24 h and 48 h after surgery in order to detect Src, BUN and Cys C and the length of ICU duration was also recorded. Results Src and Cys C of the patients in both groups obviously elevated 24h after surgery when compared with pre-operation , while BUN elevated at both 24 h and 48 h after surgery(P < 0.05). Compared with those in control group, Src, BUN and Cys C were lower in experimental group ( P < 0 . 05 ) , and the length of ICU duration was shorter (P < 0.05). Conclusion Dexmedetomidine could improve the postoperative renal function after valvular heart surgery and lead to a better prognosis.

Objective To understand the current status of hypertension in Jingzhuang Town,Yanqing District,Beijing. Method With randomized cluster sampling,3 653 residents aged over 30 yrs old were investigated by a standard questionnaire on hypertension epidemiology.Result The prevalence rate of hypertension in Jingzhuang Town was 33.3%,and increased with the age(P0.05).The main patients were those with degree 1 hypertension(62.8%).There were 37.8%of people with normal blood pressure who had high-normal values,the highest(44.3%)in 60～69 yr group.In population with hypertension,the rate of people taking medication was 24.5%,disease control rate was 8.6%,while in patients aged 30～49 yrs,these rates were 7.1%and 2.9% respectively.Conclusion The prevalence of hypertension in Beijing's suburb was serious with a younger trend.There was a large part of people with high-normal blood oressure.

Objective To studied perioperative changes in blood coagulation and the fibrinolytic system in patients undergoing acute aortic disec tion repair analyse the reason and outcome for these changes.Methods Between August 2011 and December 2011,30 patientsk[22 male and 8 female,mean aged (43.0±9.13) years] had undergone open repairs of aortic dissection or aneurysm with DHCA.Indications for surgical intervention were type A sortic dissection in 26 patients and aortic aneurysm in 4 patients.According to the time from clinical onset of the dissection to operation,acute group(less than 7 days,A group) 20 patients; chronic group (more than 30 days and aortic aneurysm,C group) 10 patients.Data were gathered for muhiple preoperative and intraoperative factors including age,sex,diagnosis,aortic dissection type,preoperative ejection fraction,aortic surgery history,surgical intervention type,cardiopulmonary bypass (CPB) time,aortic cross-clamp time,blood transfusion volume (PRBC),mechanic ventilation time,ICU length of stay and hospital length of stay.Platelet (PLT),fibrin degredation product (FDP),D-dimmer,thrombin-antithrombin (TAT),and soluble fibrin monomer complex (SFMC) were assayed before and after operation,as well as 0 h,24 h,48 h,72 h.These valuables were recorded and compared statistically between two groups.Results Preoperative serum level and postoperative peak level of FDP and D-dimmer in group A were significant higher than in gnoup C (P ＜ 0.05)and postopertive serum peak level in group C were significant higher than preoperative level (P ＜ 0.05 ).Preoperative snd postoperative most hours there was significant intergroup difference on the serum levels of SFMC and TAT (P ＜ 0.05 ).Preoperative level of PLT in group A is lower than in group C significantly (P ＜ 0.05 ).The level of PLT in each hour after surgery were much lower than the level before surgery in both group (P ＜0.05 ).In addition,thromhus fonantion in ascending aortic falsc lumen in group A was much moee common than in group C (P ＜0.05 ).There was significant difference on incidence of postoperative complications between two groups (P ＜ 0.05 ).Conclusion Activation of coagulation and fibrinolysis which results from acute aortic dissection and surgical procedure was obscrved before and after surgery to treat acute aortic dissection.There is increasing risk for consumption coagulopathy and thromboembolism during perioperative period.

Objective:To explore the application of self-teaching model based on PBL teaching combined with flipped classroom in standardized residency training of orthopedics.Methods:There were 102 cases of residents who received standardized residency training from March 2017 to February 2018 in orthopedics department of Yueyang Hospital of Traditional Chinese and Western Medicine, among whom 55 were randomized into the observation group and 47 were divided into the control group. Traditional teaching was applied in the control group and self-teaching model was applied additionally in the observation group. At the end of the month, the teaching effect was evaluated by the department graduation examinations and questionnaire survey. SPSS 19.0 was used for t test. Results:The ability of history inquiry, diagnosis and physical examination of the residents in the observation group were higher than those in the control group. The self-study and data access ability, confidence in presenting, and satisfaction with teaching in the observation group were better than those in the control group.Conclusion:The self-teaching mode can arouse the learning initiative of residents, and increase residents' literature retrieval ability and their learning satisfaction.

OBJECTIVETo evaluate the efficacy and safety of testosterone undecanoate (TU) in the treatment of late-onset hypogonadism (LOH) by meta-analysis.

METHODSWe searched Pubmed (until April 1, 2014), Embase (until March 28, 2014), Cochrane Library (until April 17, 2014), CBM (from January 1, 2001 to February 2, 2014), CNKI (from January 1, 2001 to February 2, 2014), Wanfang Database (from January 1, 2000 to February 2, 2014), and VIP Database (from January 1, 2000 to Febru ary 2, 2014) for randomized controlled trials of TU for the treatment of LOH. We evaluated the quality of the identified literature and performed meta-analysis on the included studies using the Rveman5. 2 software.

RESULTSTotally, 14 studies were included after screening, which involved 1 686 cases. Compared with the placebo and blank control groups, TU treatment significantly increased the levels of serum total testosterone (SMD = 6.22, 95% CI 3.99 to 8.45, P < 0.05) and serum free testosterone (SMD = 4.35, 95% CI 1.86 to 6. 85, P < 0.05) but decreased the contents of luteinizing hormone (WMD = -2.23, 95% CI -4.03 to -0.42, P < 0.05), sex hormone binding globulin (WMD = 2.00, 95% CI 1.38 to 2.63, P < 0.05). TU also remarkably reduced the scores of Partial Androgen Deficiency of the Aging Males (WMD = -9.49, 95% CI -12.96 to -6.03, P < 0.05) and Aging Males Symptoms rating scale (WMD = -2.76, 95% CI -4.85 to -0.66, P <0.05) but increased the hemoglobin level (SMD = 2.35, 95% CI 0.29 to 4.41, P < 0.05) and packed-cell volume (SMD = 4.35, 95% CI 1.36 to 7.33, P < 0.05). However, no significant changes were shown in aspertate aminotransferase, alanine transaminase, prostate-specific antigen, or prostate volume after TU treatment (P > 0.05).

CONCLUSIONTU could significantly increase the serum testosterone level and improve the clinical symptoms of LOH patients without inducing serious adverse reactions. However, due to the limited number and relatively low quality of the included studies, the above conclusion could be cautiously applied to clinical practice.

Androgens ; therapeutic use ; Hemoglobin A ; metabolism ; Humans ; Hypogonadism ; blood ; drug therapy ; Luteinizing Hormone ; blood ; Male ; Prostate-Specific Antigen ; Randomized Controlled Trials as Topic ; Sex Hormone-Binding Globulin ; metabolism ; Testosterone ; adverse effects ; analogs & derivatives ; blood ; pharmacology

Objective To evaluate the plasma amino acid level alteration and determine amino acid loss in patients with abdominal inflammation and acute renal failure during continuous veno-venous hemofiltration (CVVH). Methods Ten patients with abdominal infection and acute renal failure were admitted to the Nanjing General Hospital of Nanjing Military Command of PLA from September 2008 to September 2009. CVVH was performed with AV600S polysulfone hemofilter for 24 hours. Samples of plasma amino acid were obtained before,at 12 and 24 hours after the beginning of CVVH. High pressure liquid chromatography was used to detect amino acid concentrations in plasma and replacement fluid. All data were analyzed using t test or Wilcoxon rank sum test. Results Of the ten patients, three died of septic shock and three died of multi-organ dysfunction syndrome.The level of plasma amino acids decreased significantly after CVVH, and the levels of histidine, isoleucine, cysteine and glutamine decreased from (22.1 ±10.3), (20.0 ±7.6), (10.3±4.7), (122.3 ±72.2)μmol/L to (5.6 ±3.4), ( 6.4 ± 2.5 ), ( 2.9 ± 2.4 ), (42.5 ± 33.6) μ mol/L. The total plasma amino acid levels significantly reduced by 52% at 12 hours after the beginning of CVVH and by 59% at 24 hours after the beginning of CVVH.The mean amino acid loss was (9631± 1089)mg/d. The mean losses of essential and non-essential amino acids were ( 5072 ± 618 ) mg/d and ( 3747 ± 654 ) mg/d, respectively, with a significant difference ( t = 4. 52,P ＜0.05 ). There was a positive correlation between individual amino acid loss and the plasma concentrations of respective amino acids at 12 hours after the beginning of CVVH ( r = 0. 68, P ＜ 0.05 ). Conclusions Plasma amino acid would be cleared through hemofilter during CVVH in patients with abdominal inflammation and acuterenal failure. As a result, it is necessary to take account of the ultrafiltrate amino acid loss when setting nutritional schedule, especially increasing the non-essential amino acid content of total parenteral nutrition.

Objective: To compare the safety and efifcacy of platelet glycoprotein IIb/IIIa antagonist in treating STEMI patients by intracoronary-intravenous administration and intravenous administration.
Methods: We searched PubMed, Embase, Cochrane library, CNKI, VIPH and Wanfang database, the retrieval stopped at 2014-03. According to 5.0.2 Cochrane handbook, 2 scientists collected 2494 STEMI patients treated by IIb/IIIa antagonist from 20 references, and they were divided into 2 groups. Combination group, the patients received intracoronary, then intravenous administration, n=1258 and Intravenous group, the patients receive only intravenous administration, n=1236. RevMan 5.0 software was used for Meta-analysis.
Results: At 1 month after PCI treatment, compared with Intravenous group, the Combination group had better conditions of TIMI 3, TMP 3, ST segment recovery, MACE occurrence and MI area changes, all P<0.01; Combination group also showed better conditions of angina recurrence, death and post-operative target vessel revascularization, all P<0.05. LVEF was similar between 2 groups at 1 week after PCI. MI recurrence, post-operative bleeding and thrombocytopenia were similar between 2 groups at 1 month after PCI, all P>0.05.
Conclusion: Intracoronary-intravenous administration of platelet glycoprotein IIb/IIIa antagonist had the better effect for treating STEMI patients without increasing the side effects of post-operative bleeding and thrombocytopenia.

Objective: To evaluate the efifcacy and safety on clopidogrel combining proton pump inhibitor (PPI) for treating the patient after percutaneous coronary intervention (PCI) by Meta analysis.
Methods: We searched MEDLINE, EMBASE, Cochrane Library and conference databanks, the retrieval time ended at 2014-03 and 14 references were selected for Meta analysis by RevMan 5.2 software. A total of 52274 patients were enrolled and divided into 2 groups, Control group, the patients received clopidogrel, n=43809 and Combination group, the patients received clopidogrel and PPI n=8465. The efifcacy and safety were compared between 2 groups.
Results: Compared with Control group, the patients in Combination group showed increased all cause death rate (OR=1.20, 95% CI 1.05-1.37), re-myocardial infarction (MI) (OR=1.19, 95% CI 1.07-1.33) and in-steut re-vascularization (OR=1.22, 95% CI 1.08-1.39), all P<0.05; while the MACE (OR=1.29, 95% CI 0.98-1.69), in-stent thrombosis (OR=1.22, 95% CI 0.97-1.54) and gastro- intestinal bleeding (OR=0.95, 95% CI 0.55-1.67) were similar between 2 groups, all P>0.05. Further analysis found that PPI (such as omeprazole and esomeprazole) could compete the CYP2C19 enzyme location of clopidogrel, increase the risk of cardiovascular events and decrease the gastrointestinal protection.
Conclusion: Clopidogrel combining PPI may increase the risk of all cause death, MI, in-stent revascularization and decrease the gastrointestinal protection in patients after PCI, especially for omeprazole and esomeprazole which may compete the CYP2C19 enzyme location of clopidogrel.

Contemporary hospital information systems normally contain multiple applications,which are traditionally deployed as one application per server.More servers in the system will incur high system costs,low server efficiency and poor management and maintenance.The information system reform project of Wuxi Maternal and Child Health Hospital called into play the virtualization based on VMware.The project brought forth a number of merits,namely sizably raising efficiency of servers integration,simplifying server group management,reducing cost and promoting hospital informationization.