Objective To analyze the clinical prognosis and its influencing factors in elderly patients with myelodysplastic syndrome.Methods A total of 36 elderly patients with myelodysplastic syndrome were included in this study,who were diagnosed and treated at our hospital from January 2013 to August 2016.The Kaplan-Meier method was used to analyzed the survival of these patients,and the effects of gender,age,WHO classification,white blood cell count,platelet count,hemoglobin and IPSS grouping on survival were analyzed.The independent risk factors associated with the clinical prognosis of patients were identified by using multivariate Cox regression analysis.Results Patients were followed up until March 31,2017 with a follow-up time ranging from 8 to 31 months.During the follow-up period,19(58.3％)deaths and 17(41.7％) survivals were reported.The average survival time was(19.17±1.47)months.Kaplan-Meier survival analysis showed that age,WHO classification,white blood cell count,platelet count and IPSS grouping were closely associated with survival in elderly patients with myelodysplastic syndrome.Multivariate Cox regression analysis showed that age and IPSS grouping were independent prognostic factors in elderly patients with myelodysplastic syndrome.Conclusions Age,WHO classification,white blood cell count,platelet count and IPSS grouping are closely related to the prognosis of myelodysplastic syndrome in elderly patients.

Because cardiomyocytes have extremely low capacity to cell proliferation, cell transplantation has recently attracted muchattention as a new method to improve the damaged heart function and structure. Cellular cardiomyoplasty refers to the implantation ofdifferent kinds of cells besides autologous cardiomyocytes into the myocardium to reinforce its structure and function. Presently, fetaland neonatal cardiomyocytes, hematopoietic stem cells, bone marrow mesenchymal stem cells, skeletal myoblasts, endothelial stem cells, hepatic stem cells and neural stem cells have been used to repair the damaged heart in animal experiment. This article overviewstype, outcome, advantage, disadvantage, and problems of seed cells used for cellular cardiomyoplasty.

Objective To evaluate the effect of early goal-directed fluid therapy with fresh frozen plasma in severe acute pancreatitis(SAP). Methods From January 2010 to June 2014,79 SAP patients were enrolled according to the continuous sampling method. All the patients were randomly divided into a control group who accept the traditional fluid therapy(group A),an experimental group 1 who accept early goal-directed fluid therapy(group B),and an experimental group 2 who accept the early goal-directed fluid therapy with fresh frozen plasma(group C). There were no significant differences of general conditions a-mong groups. The differences of ICU admission,mortality and occurrence rate of abdominal compartment syndrome(ACS)and MODS were compared among groups. Results Compared with group A,group B and C have a shorter length of ICU admission,a lower mortality and a lower occurrence rate of ACS and MODS (P < 0. 05). Compared with group B,group C have a shorter length of ICU admission,a lower mortality and a lower occurrence rate of ACS and MODS(P < 0. 05). Conclusion The method of early goal-direct-ed fluid therapy with fresh frozen plasma will contribute to shorten the length of ICU admission and reduce mortality and occurrence rate of ACS and MODS for patients with SAP.

ObjectiveTo observe the effect and safety of postoperative patient-controlled epidural analgesia with dezocine plus ropivacaine in patients underwent hysterectomy.Methods60 patients,ASA Ⅰ ～ Ⅱ,undergoing hysterectomy operation.were randomly divided into two groups.0.225％ ropivacaine with 0.005％ dezocine ( DR group) or 0.225 ％ ropivacaine with 0.003％ morphine (MR group) were given epidurally after surgery,respectively,with an initial loading dose 5m l,basal dose of 2ml/h,PCA dose of 0.5ml and lockout time of 15 min.Visual analogue score(VAS),Bruggemann comfort scale(BCS),Ramsay sedation score(RSS),PCEA effective compression of the times and adverse effects were determined and compared at 1 h,4h,8h,12h,24h 36h and 48h after operation.PCEA effective compression of the number and incidence of adverse reactions were observed.ResultsThere were no significant differences in VAS,BCS,RSS and PCEA effective compression of the times between two groups( all P ＞ 0.05 ).The percentage of nausea,vomiting and pruritus were significantly lower in group DR than that in group MR( all P ＜0.05).ConclusionPatient-controlled epidural analgesia with dezocine plus ropivacaine in patients underwent hysterectomy had analgesic effect and safety,with less advers eeffects.

Objective To evaluate clinical therapeutic efficacy and adverse effecacy of transcatheter arterial chemoembolization(TACE)combined with radiofrequency capacitive heating(RCH) for metastatic hepatic carcinoma(MHC). Methods Thirty-nine cases of MHC were enrolled in this study and divided into two groups: study group(n = 19)and control group(n = 20). Before therapy, the Karnofsky's score of the patients was all beyond 60. Results The carcinoma growth rate of the study group was -(0.38 ? 0.22), while that of the control group was -(0.13 ? 0.25), showing significant statistical difference(P 0.05). Conclusion The therapeutic effect of MHC can be further improved by the treatment of TACE combined with radiofrequency capacitive heating without increase of adverse side effects.

Objective:To summarize acute type A aortic dissection(ATAAD) is relatively uncommon in dialysis patients, and repair outcomes are not fully understood.Methods:Between January 2014 and March 2020, 20 patients with ATAAD required dialysis for preoperative end-stage renal disease(ESRD) were treated by our group. There were 11 male and 9 female patients at mean age of(47.8±11.3) years. The mean duration of dialysis therapy in the total 20 patients before the onset of ATAAD was(4.5±3.9 )years, with 90%(18 cases) of these patients undergoing hemodialysis(rather than peritoneal dialysis). 17 patients were treated emergency surgically, surgical operation were performed under deep hypothermic circulatory arrest and perfused the cerebral selective cerebral perfusion, 5 cases with ascending aorta + arch fenestrated stent, 5 cases with ascending aorta+ hemi-arch replacement(2 cases with stent elephant trunk), 4 cases with ascending aorta+ arch replacement+ stent elephant trunk(1 case with coronary artery bypass grafting for left anterior descending coronary artery), 2 cases with aortic valvuloplasty + ascending aorta+ hemi-arch replacement, 1 case with Bentall+ arch fenestrated stent.Results:2 patients were died from aortic ruptured before operation, 1 patient treated medically was alive three months after admission. Cross-clamp, cardiopulmonary bypass, and circulatory arrest times of all the surgical patients were(233.8±84.4) min, (155.5±63.6)min and(28.2±10.8)min, respectively. The following complications occurred postoperative: 3 cases died in the hospital, 1 case of tracheotomy, 2 cases of cerebral infarction, 1 case of cerebral hemorrhage, 1 case of transient paraplegia, and 1 case of surgical site infection. After a mean follow-up of(11.6±14.5) months(rang, 3-61 months). the overall survival rate at 1 year and 5 years was 53% and 27% respectively.Conclusion:Dialysis patients with ATAAD should be operated on urgently and medical treatment carries high risks of aortic rupture, although in-hospital mortality is acceptable, long-term mortality is poor.

Aim To study the effects of telmisartan upon serum calcineurin.Methods 92 male SD rats with the same age were randomly divided into control group (N), sham operation group (S), 2K1C+distilled water group (K) and 2K1C+telmisartan group (T).S rats were performed the open-abdomen surgery without being restricted any renal artery, but the K and the T rats were restricted their left renal artery. Beginning from the third week after the surgery, the K rats started to be treated with the intragastric infusion of distilled water 10 ml·(kg·d)~(-1) , while the T rats with telmisartan 10 mg·(kg·d)~(-1) .And after being treated for 2, 4 and 8 weeks, rats were respectively measured the systolic blood pressure (SBP), the diastolic blood pressure (DBP) of the abdominal aorta. Before and after the operation, ultrasonography with probe of 7.5 MHz was used to obtain the structure and functional indexes, such as IVSd, IVSs, LVPWd, and serum calcineurin were evaluated by ELISA and colorimetric assay kit.Result Compared with the S group and the N group, ① the results of blood pressure (SBP, DBP) were significantly higher in K group (all P <0.01), after use of telmisartan, blood pressure was significantly reduced(P <0.01);② the thickness of interventricular septal and left ventricular posterior wall at the end of diastolic and systolic were significantly higher in K group (all P <0.01), after use of telmisartan, the thickness of those declined(all P <0.01);③ the level and activity of serum calcineurin were significantly higher in K group (all P <0.01), after use of telmisartan, the level and activity of calcineurin significantly fell(P <0.01).Conclusion The serum calcineurin of artery was also raised in the left ventricular remodeling. Telmisartan ameliorates ventricular remodeling effectively, which may be associated with decreasing the expression of artery serum calcineurin.

Objective To investigate the clinical value of different double-J tube indwelling time in the treatment of ureteral stone-street complications after flexible ureteroscope lithotripsy. Methods Clinical data of 64 kidney calculi patients with ureteral stone-street complications after flexible ureteroscope holmium laser lithotripsy were retrospectively analyzed. The patients were divided into observation group (extubating the double-J tube 2 weeks after the surgery) and control group (retaining the double-J tube) with 32 cases in each group. The calculi clearance results and complication were compared between 2 groups. Results The success rate of stone removal in observation group was significantly higher than that in control group: 100.0% (32/32) vs. 65.6%(21/32), the calculi elimination time was significantly shorter than that in control group:(26.4 ± 6.6) d vs. (45.3 ± 10.9) d, the treatment cost was significantly lower than that in control group:(768.4 ± 152.6) yuan vs. (1 262.3 ± 156.8) yuan, the incidences of irritation symptoms of bladder and macroscopic hematuria were significantly lower than those in control group: 15.6% (5/32) vs. 90.6%(29/32) and 15.6% (5/32) vs. 100.0% (32/32), and there were statistical differences (P<0.05). There was no statistical difference in incidence of renal colic between 2 groups (P>0.05). Conclusions Removing the double-J tube 2 weeks after flexible ureteroscope lithotripsy results in higher stone clearance rate and less complications compared with retaining the double-J tube. It can reduce the occurrence of irritation symptoms of bladder, macroscopic hematuria and treatment cost.

Objective To investigate the acute myocardial infarction (AMI) patient's electrocardiogram appearing fragment QRS wave (fQRS) and brain natriuretic peptide (BNP) level and scope of coronary lesions,severe cardiac complications,and the cor relation of cardiac death.Methods For selected patients with AMI,whether based on electrocardiogram (ECG) appeared in fQRS group and non fQRS groups; immunofluorescence technique was used to detect the plasma BNP level in patients with AMI.Two groups of patients with serious cardiac events and coronary artery lesions scope were observed; Coronary artery lesion count and BNP level were recorded.Results The incidence of fragment QRS wave in patients with AMI was 34.0％,fQRS wave group height/three degree atri oventricular block,ventricular tachycardia/ventricular fibrillation,cardiac shock,cardiac death rate was higher than non fQRS wave group (P ＜0.05).fQRS wave group of plasma BNP and left ventricular end-diastolic diameter,the double branch lesion,multivessel lesions were significantly higher than that of non fQRS group (P ＜ 0.01) ; left ventricular ejection fraction,the single lesion was sig nificantly lower than non fQRS wave group (P ＜0.01).The BNP levels in single,double,and multivessel lesions in the group with the increase of the lesion count were increased.Conclusions The AMI patients with fQRS easily complicated with severe arrhythmia,and case fatality rate was high,the prognosis was poor.fQRS on electrocardiogram (ECG) and BNP level had a certain relationship with range and degree of coronary artery lesions,degree of indexes might be used as a prediction of coronary lesions,and multivessel lesions had certain prediction value.