Objective To explore the value of neutrophils gelatinases related lipid a carrier protein (NGAL),renal injury molecule-1 (KIM-1) and serum creatinine (SCr) for early diagnosis in adult cardiac surgery after acute renal injury (AKI).Methods Blood and urine samples of 65 cardiac surgery patients before and 24,48,72 h after surgery were collected,SCr,urine NGAL and KIM-1 levels was detected,among whom AKI occurred in 34 cases(AKI group),did not occur in 31 cases (non AKI group),and they were compared with 20 cases of healthy physical examination (control group).Logistic regression model was used to judge the value of early diagnosis of SCr,urine NGAL and KIM-1.Results The incidence of AKI after cardiac surgery was 52.31％ (34/65).The SCr,urine NGAL and KIM-1 levels in AKI group and non AKI group before and 24,48,72 h after surgery were significantly higher than those in control group [SCr:(62.44 ±22.26),(77.38 ±24.38),(98.24 ±25.02),(98.14 ±45.26)μmol/L and (56.67 ±21.68),(59.25 ± 15.58),(55.40 ±22.91),(40.10 ±23.45)μmol/L vs.(16.43 ±5.01)μmol/L;urine NGAL:(4.81 ±0.65),(9.48 ±3.29),(11.87 ±3.93),(7.66 ± 1.52) μg/L and (4.67 ±0.53),(8.89 ± 2.64),(11.46 ± 3.60),(7.47 ± 1.63)μg/L vs.(2.87 ± 0.48) μg/L; KIM-1:(47.93 ± 5.54),(61.89 ± 12.44),(100.21 ± 27.32),(67.69 ± 8.72) μ g/L and (47.12 ± 4.08),(56.38 ± 9.27),(90.14 ± 27.26),(69.40 ±8.90) μ g/L vs.(32.21 ± 12.54)μ g/L] (P ＜ 0.01).Urine NGAL and KIM-1 levels in AKI group and non AKI group 24,48,72 h after surgery were significantly higher than those before surgery (P＜ 0.01).SCr,urine NGAL and KIM-1 levels in AKI group 24 h after surgery were significantly higher than those in non AKI group (P＜ 0.01).Twenty-four hours after surgery,the sensitivity and specificity of urine NGAL,KIM-1 in the diagnosis of AKI,compared with that of SCr had no statistical significance (P ＞ 0.05).Conclusions The adults who accept extracorporeal circulation cardiac surgery appear high incidence of AKI.Twenty-four hours after surgery,early biological markers-urine AKI,KIM-1,has similar sensitivity and specificity with traditional diagnostic gold standard of SCr.

OBJECTIVE:To provide references for the improvement of licensed pharmacists associations in China.METHODS:To analyze the misunderstanding of marketing and marketing strategies of the licensed pharmacists associations in China.RESULTS&CONCLUSIONS:The licensed pharmacists associations in China should acquire the marketing idea of market guide and society guide,and optimize grouping the product strategies,place strategies,promotion strategies,prize strategies in order to realize the goal of marketing management of the organization.

Objective To observe the effects of fastigial nucleus stimulation(FNS)combined with rehabilitation on vascular dementia.Methods63 vascular dementia patients were randomly divided into FNS group(40 patients)and control group(23 patients).Patients in the FNS group were treated with FNS and rehabilitation therapy,while those in the control group were treated with rehabilitation therapy only.Cognitive function were evaluated with Mini-Mental State Examination(MMSE),activities of daily living(ADL)were evaluated with Barthel Index(BI),cerebral blood flow velocity before and after therapy was detected with transcranial Doppler(TCD).ResultsThe scales of MMSE and BI increased significantly;the clinical efficiency was 95%.Cerebral blood flow velocity after therapy improved significantly(P<0.01).ConclusionFNS can improve the cognitive function and ADL in vascular dementia patients,that may be related with the improvement of cerebral blood flow.

Objective To evaluate sleeve gastrectomy with ileal interposition and duodenojejunal bypass for the treatment of nonobese Type 2 diabetes mellitus.Methods Forty one patients of nonobese Type 2 diabetes mellitus underwent sleeve gastrectomy with ileal interposition and duodenojejunal bypass.Fasting glucose ( FPG ),glycosylated hemoglobin ( HbAlc ),fasting insulin and C-peptide,triglycerides (TG),high density lipoprotein(HDL),low density lipeprotein(LDL) were measured preoperatively and on postoperative first,3rd,6th month.Results Mean postoperative follow-up was 9.6 months (range 6-21 months).95％ patients achieved adequate glycemic control (HbAlc ＜ 7％ ) without antidiabetic medication.Fasting glycemia decreased from ( 9.7 ± 0.4 ) mmol/L to ( 6.2 ± 0.3 ) mmol/L ( P ＜ 0.01 ).Glycosylated hemoglobin decreased from 8.1％ ± 1.4％ to 5.8％ ± 0.6％ ( P ＜ 0.01 ).2-hour postprandial blood glucose decreased from ( 13.6 ± 0.7 ) mmol/L to ( 10.6 ± 0.2 ) mmol/L ( P ＜ 0.01 ).Insulin resistance (Homa-R) decreased from 4.8 ± 1.3 to 1.2 ±0.4 (P ＜0.01 ).Fasting C-peptide increased from ( 3.3 ± 1.7 ) ng/ml to (4.9 ± 0.2 ) ng/ml ( P ＜ 0.01 ).Fasting insulin increased from ( 10.2 + 1.4 ) mlu/L to (15.6±0.7) mlu/L(P＜0.01 ).Triglycerides (TG) decreased from (3.1 ±0.5) mmol/L to (1.9 ±0.4) mmol/L ( P ＜ 0.01 ).High density lipoprotein (HDL) increased from ( 1.2 ±± 0.2 ) mmol/L to ( 1.9 ±0.8 ) mmol/L( P ＜ 0.01 ).Low density lipoprotein (LDL) decreased from (3.5 ± 0.3 ) mmol/L to (2.4 ±0.6) mmol/L (P ＜0.01 ).Hypertension was controlled in 3/7 cases.Microalbuminuria resolved in 78％ patients.Retinopathy was improved in 53％ cases.Conclusions Sleeve gastrectomy with ileal interposition duodenojejunal bypass is effective for treatment of nonobese type 2 diabetes mellitus as showed by 6 month's follow-up.

Objective:To systematically review the teaching effects of flipped classroom (FC) in undergraduate medical education in China.Methods:Such databases as CNKI, VIP Data, and WanFang, were electronically searched for literature of randomized controlled trials (RCTs) on FC versus lecture-based learning (LBL) applied in medical education in China up to March, 2018. The included literature were evaluated for the quality, and RevMan5.3 software was used for Meta-analysis.Results:A total of 26 RCTs were included in the study, including 4 249 students, of whom the FC group had 2 135 cases, while LBL group had 2 114 cases. The students in FC group got significantly higher scores than those of the students in LBL group in the theoretical scores (WMD = 7.81, 95%CI = 5.18 -10.43, P < 0.05), skills tests (WMD = 4.69, 95%CI = 0.65 -8.73, P < 0.05). Conclusion:The FC can significantly improve the teaching results in undergraduate medical education.

Twenty nine moderately halophilic bacteria isolated from salt lakes in Xinjiang Region were compared with nine reference strains of relative species by performing a numerical analysis of 112 phenotypic characteristics. All the new isolates are Gram negative and can grow on the media containing 0～25% NaCl. The results showed that all tested strains were clustered into 2 phena at 76 % similarity level. Phenon I was composed by 25 new isolates strains,and phenon II included 9 reference strains and 4 new lsolated strains. Most of the new isolated strains were clusted into 3 subphena at 86 % similarity level. There were 10 new isolated strains in subphenon 1, 8 new isolated strains in subphenon 2, and 1 new isolated strain and 5 reference strains were included in subphenon 3. The results indicated that there were great differences between the new isolates and the reference strains.

Objective To evaluate the early effects on insulin resistance following sleeve gastrectomy with ileal interposition duodenojejunal bypass operation.Methods From Jun.2010 to Sep.2011,37 cases of type 2 diabetes mellitus patients [23 male,14 female; mean age (45.2 ± 2.4) years,mean BMI (21.7 ± 1.8) kg/m2] underwent sleeve gastrectomy with ileal interposition duodenojejunal bypass operation.Fasting plasma glucose(FPG),fasting insulin(FIns),body mass index(BMI),and homeostatic model assessment for insulin resistance (HOMAIR) were detected before surgery and on the 10th,20th,30th,and 60th day after surgery.Results The level of FPG was (6.8 ± 0.7) mmol/L,(7.2 ± 0.6) mmol/L,(6.9 ± 0.3) mmol/L respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery[(10.2 ±0.4)mmol/L].The difference had statistical significance (P ＜ 0.05).The level of Fins was (6.3 ± 1.1) mIu/L,(7.1 ± 1.3) mIu/L,and (7.3 ± 1.6) mIu/L respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery[(12.6 ± 1.4)mIu/L].The difference had statistical significance (P ＜ 0.05).The level of lnHOMA-IR was 0.7 ± 0.2,0.9 ± 0.5,and 0.8 ±0.4 respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery (1.8 ±0.6).The differenc had statistical significance(P ＜0.05).However,the change of BMI was not obvious between before surgery and on the 10th,20th,and 30th day after surgery.The difference had no statistical significance (P ＞ 0.05).on the 60th day after surgery,the level of FPG,Fins,lnHOMA-IR and BMI was significantly reduced compared with that before surgery.The difference had statistical significantce(P ＜0.05).Conclusion After sleeve gastrectomy with ileal interposition duodenojejunal bypass operation,the early improvement of insulin resistance occurs rapidly and it is iadependent of the loss of BMI.

Objective To study the effect of three-dimensional (3D) animation on preoperative anxiety in patients with lumbar disc herniation (LDH). Methods One hundred and eighty-four LDH patients were randomly divided into experiment and control group in equal number. The control group was educated in traditional method and the experiment group in the form of 3D animation. The self-rating anxiety scale (SAS) was used for the assessment 2 h after admission into the hospital and 1d before operation. Results After the intervention, the score by SAS in the observation group was significantly lower than that before the intervention and control groups (P<0.001). The score by SAS in the control group was significantly lower than that of the control group and that before intervention (P<0.001). Conclusion Health education by 3D animation can relieve preoperative anxiety in the patients with lumbar disc herniation.

Objective To observe the therapeutic effect of multidisciplinary rehabilitation therapy on patients with angina pectoris of coronary heart disease.Methods 86 patients with angina pectoris of coronary heart disease were randomly divided into the rehabilitation group(55 cases)and control group(31 cases).The patients in the rehabilitation group received routine drugs and multidisciplinary rehabilitation(psychotherapy,diet guiding,kinesitherapy,post discharged guiding etc).The patients in the control group received routine drugs for 10～14 days,activities after chest pain dispearance and natural life after discharge.The follow up period was 6 months,recording the changes of cardiac event rate,body mass index,blood lipid(glycerol,cholesterol,low-density lipoprotein).Results The rehabilitation group was significantly superior to that of control group in symptom remission velocity and remission degree(P<0.05).Cardiac event rate of the rehabilitation group was lower than that of the control group significantly within follow up period(P<0.01);body mass index and blood lipid were improve in the two groups,but the rehabilitation group was significantly superior to that of the control group(P<0.05).Conclusion The multidisciplinary rehabilitation therapy can improve clinical symptoms of patients with angina pectoris of coronary heart disease and reduce cardiac event.

Objective To observe the effects of long-term low dose arsenic exposure through drinking water on learning ability of different generations of C3H and Balb/c mice.Methods Mice (C3H and Balb/c) were exposed to arsenic at 0 mg/L (control) and 85 mg/L (20 female mice and 10 male mice per group).The control group and F1,F2,F3 and F4 mice were selected and divided into 5 experimental groups,8 mice in each group.Their offsprings were detected by the Morris water maze test (the average escape latency of 1 to 5 days) and spatial probe test (the times of through target area on the sixth day).Statistical analysis was performed with SPSS 18.0 software.Results The average escape latencies of 1 to 5 days in C3H control group were (48.09 ± 2.63),(46.09 ± 3.27),(42.72 ± 3.29),(39.31 ± 2.69) and (36.75 ± 3.92) s,F1 were (49.59 ± 3.29),(47.34 ± 3.01),(44.28 ± 6.58),(44.50 ±1.67) and (42.16 ± 2.27) s,F2 were (51.41 ± 0.78),(48.88 ± 1.45),(45.54 ± 1.46),(43.94 ± 1.69) and (42.22 ± 3.27) s,F3 were (50.91 ± 4.20),(49.78 ± 5.18),(48.03 3.45),(46.16 ± 4.42) and (44.06 ± 1.04) s,F4 were (52.66 ± 4.60),(52.38 ± 5.78),(49.06 ± 1.22),(47.69 ± 2.34) and (46.47 ± 1.56) s.The average escape latencies of Balb/c control group were (50.91 ± 2.84),(47.03 ± 4.22),(45.56 ± 4.53),(39.72 ± 5.90) and (36.22 ± 4.85) s,F1 were (50.47 ±3.20),(48.25 ± 6.53),(47.13 ± 1.25),(43.72 ± 4.27) and (40.66 ± 4.52) s,F2 were (51.31 ± 4.73),(48.88 ± 1.53),(46.56 ± 1.43),(44.25 ± 1.16) and (41.20 ± 3.79) s,F3 were (51.72 ± 3.54),(50.78 ± 4.45),(45.03 ± 3.56),(41.19 ±5.63) and (42.81 ± 6.29) s,F4 were (53.34 ± 4.60),(52.34 ± 2.77),(48.72 ± 5.92),(46.97 ± 7.38) and (44.94 ± 1.75) s.On the fourth and fifth days of F1,F2,F3 and F4 generations of C3H,the escape latencies between generations were significantly different (all P ＜ 0.05).The times of through target area in the sixth day of the C3H control group and F1,F2,F3 and F4 mice were 2.25,1.75,1.63,1.50 and 1.38,Balb/c were 2.13,1.75,1.63,1.38 and 1.13.Conclusion Arsenic accumulation due to serial passage of C3H and Balb/c through long-term low doses arsenic exposure through drinking water has resulted in decreased learning and memory ability.