Objective To investigate the effect of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 200/0.5 on mucous membrane of small intestine in rabbits. Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly divided into 4 groups ( n = 8 each): Ⅰ control group underwent no ANH, and Ⅱ, Ⅲ, Ⅳ group underwent ANH with hematocrit (Hct) reduced to 24%, 18% and 12% respectively (group H1-3 ). The animals were anesthetized with 20% urethane 4 ml/kg, thracheostomized and mechanically ventilated (VT = 8 ml/kg, RR = 50 bpm). The body temperature was maintained at 36.5-37.6 ℃. Left carotid artery was cannulated for MAP monitoring and blood sampling. Right jugular vein was cannulated for CVP monitoring. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Blood samples were obtained from superior mesenteric vein (SMV)for determination of plasma concentrations of TNF-α before ANH(T0) and at 8 h after ANH (T1). Small intestinal mucosal tissues were obtained at T1 to observe the pathological changes by electron microscopy. Results Compared with those at T0, plasma concentrations of TNF-a in SMV were significantly increased at T1 in group H2 and H3 ( P ＜ 0.01 ), but no significant change was found in group H1 ( P ＞ 0.05). Compared with group C, plasma concentrations of TNF-α in SMV were significantly increased in group H2 and H3 ( P ＜ 0.01 ), but no significant change was found in group H1 ( P ＞ 0.05). No injury was found in mucous membrane of small intestine in group H1 . The injury to mucous membrane of small intestine was mild in group H2 and severe in group H3 . Conclusion ANH with 6% HES 200/0.5 does not affect mucous membrane of small intestine when Hct is reduced to 24% The injury to mucous membrane of small intestine occurs when Hct is reduced to≤ 18%.

Objective To study the hydrogen sulfide productivity by mononuclear cells in patients with atrial fibrillation (AF). Methods Mononuclear cells were extracted from peripherial blood of 60 AF patients and 30 healthy controls. Modified methylene blue method was used to evaluate the hydrogen sulfide productivity of mononuclear cells. Results Hydrogen sulfide productivity of mononuclear cells from AF patients was 92.5%higher than that from control [10.63 (8.21~14.37) μmol/(min.g protein) vs 5.52 (4.42~8.50) μmol/(min.g protein)]. Hydrogen sulfide productivity of mononuclear cells was correlated with the left atrial transverse diameter (r = 0.276,P < 0.01), while no significant correlation was found between hydrogen sulfide and left ventricular end-diastolic diameter , left atrial anterior posterior diameter , C-reaction protein etc. Conclusion Hydrogen sulfide productivity of mononuclear cells from AF patients is promoted.

Objective To evaluate the relationship between the heart diastolic function and pulse wave velocity in patients with diabetes mellitus.Methods Fifty-five patients with diabetes mellitus underwent echocardiogram exam,PWV,and BNP determination.Patients were divided into two groups according to the results:the group with normal heart diastolic function(n =33)and the group with abnormal heart diastolic function( n =22).Another 30 healthy volunteers served as control group.The values of PWV were compared.between the three groups.The relationship between E/E' and PWV,BNP and PWV were evaluated with correlation analysis.Results The PWV value of abnormal heart diastolic function group was significantly higher than that of other two groups.PWV was positively correlated with E/E'and BNP ( r =0.58,P ＜ 0.05 ; r =0.63,P ＜ 0.05).Conclusion PWV is associated with the heart diastolic function.PWV can serve as an important factor to predict abnormal heart diastolic function in patients with diabetes mellitus.

Objective To analyze the incidence of capsular contracture in breast augmentation with smooth versus textured breast implants using a Meta method.Methods Terms such as breast augmentation, capsular contracture, smooth implant, textured implant, breast implant were searched in databases such as MEDLINE,EMBASE,Cochrane Library,CBM and VIP.Documents about breast augmentation with textured and smooth implants were totally collected,and the data of these trials were extracted to obtain a pooled odds ratio of capsular contracture and other complications.Meta analyses were performed by RevMan 5.2 software to estimate the combined effect values.Results Eleven clinical controlled trials were included.The results of meta analysis showed that textured implants group and smooth implant group presented the risk of capsular contracture combined OR=0.32 (95％ CI,0.18 to 0.58,P=0.0002),and also presented the risk of other complications combined OR=1.31 (95％ CI,0.96 to 1.77,P=0.09).Conclusions Compared with smooth implants,textured implants reduce the risk of capsular contracture after breast augmentation.

Objective To evaluate the efficacy and safety of caspofungin in the treatment of invasive fungal disease (IFD) in advanced age patients. Methods A retrospective analysis of the clinical data was conducted. IFD patients who had received caspofungin treatment in elderly wards were included. Results From January 2007 to August 2009, 29 IFD patients aged 80-100 years (mean 89 ) were treated with caspofungin. Except that one patient dead on the first drug administration day, there were 28 evaluable patients, 13 were cured (46.4%), 6 were markedly improved (21.4%), 3 progressed (10.8%) and 6 dead (21.4%). The overall effective rate was 67. 8%. Of 13cured patients, 12 were Candida bacreremia, 1 was Candida albicans disease of lung. Of 6 dead patients, 2 were Candida bacteremia, 1 was Candida albicans disease of lung and 3 was suspected of lung IFD. One patient performed that alanine aminotransferase was increased, considering drug-related impairment of liver function. Conclusions Caspofungin is effective and safe in the treatment of IFD in advanced age patients.

Objective To explore the expression and significance of Kiss-1, Ki-67 and VEGF-C in papillary thyroid carcinoma(PTC) and thyroid follicular adenoma (FA).Methods Forty-four cases of PTC and twelve cases of FA paraffin-embedded tissues were used .Immunohistochemical staining and microscopic image analysis technique were used to analyze the expression of Kiss-1, Ki-67 and VEGF-C.Results The integrated optical density (IOD) of Kiss-1, and VEGF-C in the PTC groups was 475.56 ±126.02 and 805.29 ±226.05,respectively.The proliferation index of Ki-67 protein was (3.36 ±1.11) %and the difference between the PTC and FA groups was statistically significant (P<0.05).The IOD of the above two indices was 408.12 ±124.05 and 912.63 ±108.12 in the PTC with lymph node metastasis group , respectively, while the proliferation index of Ki -67 protein was (3.93 ±0.92) % and the difference vs the group without lymph node metastasis was significant ( P <0.05 ) .In the PTC with capsular infiltration group the IOD of above two was 425.58 ±87.38 and 891.37 ±149.36, the proliferation index of Ki -67 protein was (3.79 ±1.09) %and the difference with PTC group without capsular infiltrtion was statistically significant (P<0.05).Linear correlation analysis showed that Ki-67 and VEGF-C were with positively correlated in PTC and FA tissues (P<0.05),while Kiss-1 and Ki-67, VEGF-C were with negatively correlated in PTC and FA tissues (P<0.05).Conclusion Kiss-1, Ki-67 and VEGF-C can facilitate the differential diagnosis of PTC and FA , serving as prognostic indicators in patients with PTC .

Objective To evaluate the specificity,sensitivity and accuracy of miniature probe combined with radial scanning endoscopic ultrasonography(EUS)in preoperative TN staging of rectal cancer,and to assess its value in the choice of therapeutic strategy.Methods A total of 60 patients with rectal cancer received EUS assessment before surgery.Diagnosis was made according to TNM standard and compared with those of MRI and postoperative pathological examination.The reference value of EUS for therapy selection was studied.Results According to EUS staging,there were 4 cases of TI,18 T2,30 T3 and 8 T4,among which 7 cases were over-staged and 4 others were under-staged.MRI staging showed 1 case of T1,18 T2,30 T3 and 10 T4,among which 14 were over-staged and 3 others were under-staged.The total accuracy of EUS in T staging and N staging was 81.67%(49/60)and 78.33%,respectively,with the sensitivity and specificity at 71.43%and 91.03%,respectively.Accuracy of MRI for T staging and N staging were 71.67%(43/60)and 83.33%,respectively,with the sensitivity and specificity as 85.71%and 86.96%.Conclusion EUS with combination of miniature probe and radial scanning is effective in preoperative TN staging of rectal cancer with easy manipulation and less pain.

Objective To predict the risk of 28-day mortality in septic patients in intensive care unit (ICU) with the combination of Weighted index of comorbidities (WIC) and sepsis-related organ failure assessment (SOFA) score.Methods The clinical data of adult severe sepsis/septic shock patients in Department of Emergency Medicine of Changzheng Hospital and Department of Critical Care Medicine of Jinan Military General Hospital from October 2011 to February 2013 were analyzed retrospectively.The etiological factor,past history,having severe sepsis or not were recorded.Age score,WIC score,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and SOFA score were calculated at or 24 hours after admission.The logistic regression was used and the receiver operating characteristic curve (ROC curve) was drawn to calculate the patients' outcome.Results In 310 enrolled patients,223 (71.9％) patients survived and 87 (28.1％) died.Univariate analysis showed that the P values of the age score,WIC score,APACHE Ⅱ score and SOFA score,chronic cardiac insufficiency,type 2 diabetes,cerebrovascular disease,tumor,multiple injury,pulmonary infection and having severe sepsis or not were all less than 0.2.The above 11 variables were put into the multivariate logistic regression equation 1,of which predicted probability was reserved.It revealed that 5 variables were independently associated with 28-day prognosis,of which influence power in descending order were SOFA score [odds ratio (OR) =1.308,95％ confidence interval (95％ CI):1.158-1.478,P=0.000],having severe sepsis or not (OR =0.206,95％ CI:0.100-0.424,P=0.000),APACHE Ⅱ score (OR =1.090,95％CI:1.021-1.164,P=0.010),WICscore (OR=1.441,95％CI:1.067-1.947,P=0.017),agescore (OR=1.228,95％CI:1.027-1.468,P=0).024),the Walswere 18.554,18.369,6.725,5.662,5.067,respectively.The 3 variables,age score,WIC score and SOFA score,were brought into the multivariate logistic regression equation 2,of which predicted probability was reserved too.It revealed that age score (OR=1.330,95％CI:1.145-1.546,P=0.000),WIC score (OR =1.496,95％ CI:1.145-1.546,P=0.000) and SOFA score (OR =1.429,95％ CI:1.303-1.567,P=0.000),were independently associated with the septic patients' 28-day prognosis.There was no significant difference in the area under receiver operating characteristic curve (AUC) between the SOFA score and APACHE Ⅱ score (0.784 vs.0.780,Z=0.014,P=0.989).However,compared with APACHE Ⅱ score,the AUC of equation 1 (0.888) and 2 (0.851) were much more (Z=4.333,P=0.000; Z=2.669,P=0.008).Conclusion The sensitivity of 28-day prognosis by WIC score was improved greatly with the combination of SOFA score and age score.

Objective To discuss the effect and safety about large dosage of tilofiban injection into coronary artery in patients with ST-segment elevated myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods A prospective study was conducted. Two hundred and eighteen patients with STEMI admitted into Cardiology Department of Taizhou Central Hospital were enrolled. According to the difference in dosage, they were divided into a large dosage tilofiban group (102 cases) and a routine dosage tilofiban group (116 cases). In both groups, they received the injection of load dosage of tilofiban into coronary artery during they underwent primary PCI, the load dosage being 25μg/kg in the large dosage group, and 10μg/kg in the routine dosage group. Afterwards, the dosage was kept on 0.15μg·kg-1·min-1 in both groups lasting for 18-24 hours. The flow of thrombolysis in myocardial infarction (TIMI) immediately after PCI, the return of ST-segment after operation for 2 hours, the rate of bleeding events, the rate of major adverse cardiac event [MACE, including death, re-infarction and target vessel revascularization (TVR)] and prognosis after operation for 30 days were observed. Results The ratios of the immediate reflow of TIMI 3 grade after operation and the return of ST-segment after operation for 2 hours in the large dosage tirofiban group were higher than those in the routine dosage tirofiban group [the ratio of the reflow of TIMI 3 grade:92.16%(94/102) vs. 81.90%(95/116), the ratio of the return of ST-segment after operation for 2 hours:89.22%(91/102) vs. 73.28%(85/116), both P < 0.05]. The ratios of re-infarction, TVR and the total MACE in 30 days after operation in large dosage tirofiban group were lower than those in the routine dosage tirofiban group [re-infarction: 0.98% (1/102) vs. 2.59% (3/116), TVR: 0.98% (1/102) vs. 2.59% (3/116), total MACE: 1.96% (2/102) vs. 6.03% (7/116), all P < 0.05]. There were no statistically significant differences in mortality and the bleeding events between the large dosage tirofiban group and routine dosage tirofiban group [mortality:0 (0/102) vs. 0.86%(1/116), bleeding events:1.96%(2/102) vs. 0.86%(1/116), both P>0.05]. Conclusion The injection of a large dosage of tilofiban into a coronary artery in patients with STEMI undergoing primary PCI is an effective and safe method to allow them to get more clinical benefits.

OBJECTIVE:To demonstrate challenges of pharmacy automation reconstruction so as to set solutions. METHODS:Based on literature review,analysis of pharmacy automation setting and features,this paper gave the suggestions and solutions on construction cost,management model change,equipment maintenance and emergency response,etc. according to the practice of the hospital. RESULTS&CONCLUSIONS:Pharmacy automation construction should be stick to the requirements of new health re-form to lower the cost by using the out resources and interior optimal allocation,to improve efficiency by unified planning and proper design,and to ensure the system running efficiently by sufficient maintenance and contingency plan.