Objective To analyze the incidence,risk factors,and impact of intraoperative conversion on the mortality in patients undergoing off-pump coronary artery bypass grafting.Methods This retrospective observational study included 207 patients undergoing off-pump coronary artery bypass grafting.According to whether intraoperative conversion,207 patients were randomly divided into intraoperative unchanged group(191 cases)and intraoperative changed group(16 cases).The incidence,patient characteristics,cause of intraoperative conversion,and its impact on outcome were studied.Results Intraoperative conversion increases odds for mortality to 25.0%,while the other group was 1.0%.The most common cause for intraoperative conversion was hemodynamic disturbances during grafting to the obtuse marginal artery.On multivariate logistic regression analysis,left main disease,mitral regurgitation and higher EuroSCORE II independently predicted intraoperative conversion.Conclusion Intraoperative conversion to on-pump coronary artery bypass grafting is independently associated with higher mortality in patients undergoing off-pump coronary artery bypass grafting.Identification of high risk group of intraoperative conversion may improve the outcome.

Objective To explore the relationship of preoperative hemoglobin concentration and use of hospital resources.Methods 108 patients receiving cardiac surgery in the central hospital of wuhan were included.The relationship of preoperative hemoglobin concentration was explored on blood transfusion rates,return to the operating room for bleeding and/or cardiac tamponade,postoperative intensive care unit(ICU)and in-hospital length of stay,and mortality.Results For every 10-unit increase in hemoglobin(g/L),blood transfusion requirements were reduced by 8.0%,6.0%,and 3.0% for red blood cell units,platelet pools,and fresh frozen plasma units,respectively.For each 10-unit decrease in hemoglobin(g/L),the probability(over time)of discharge from the ICU and hospital increased 7.0%,16.0% respectively.Conclusion A lower preoperative hemoglobin concentration resulted in increased use of hospital resources after cardiac surgery.Therefore,the correction of decreasing preoperative hemoglobin concentration could improve the use of hospital resources after cardiac surgery.

It is very important to assess the role of suitable social medical support level in operation and adjustment of social medical insurance system.The social medical support level in Shandong Province was measured and analyzed,the coordination of social medical support level and economic development was emphasized with suggestions put forward for the development of system and optimization of policies.

The clinical skills competitions for national medical students in China have been well organized for five times.Experience has been accumulated,and much has been emphasized on the low assessment efficacy throughout the competitions.However,few solutions has been brought about to conquer such problem.This article mainly focused on introducing a computerized clinical skill assessment system based on current clinical skills competition assessment.The system realizes functions such as team management,online marking,score calculation,data analysis,and real-time result presentation.Such appliance of computer,internet and information technology on conventional clinical skills evaluation could hopefully replace the traditional manual calculating procedures,improving the efficiency of the future competitions,to ensure their openness,impartiality,and equitability,as well as to deliver observatory appeal among audience.

Objective To study a wavelet method for acquiring the characters of pulse wave based on the principle of wavelet transform which can effectively solve the problem of inaccuracy of the conventional methods. Method The method of wavelet module maximum was used to divide the pulse wave according to periods and basically decomposed it, by arranging in time order and symbolizing the module maximum character points of pulse wave signal at the ascending and descending edges as well as the crest and trough. Result Through the method, the unobvious dicrotism, trail wave and the anomalistic wave appearing at the ascending and descending edge of the main wave, and multi-scale characters and all kinds of characters in time domain of pulse signal were further acquired more accurately. Conclusion Simplicity, quickness and accuracy are achieved by focusing on the character points of pulse signals. It provides a new means for further studies of classification and identification of pulse signals.

OBJECTIVE:The bioassay and HPLC methods were established and compared for the determination of levofloxacin(Lev) in human plasma.METHOD:In bioassay,medium Ⅱ and staphylococcus aureus were used.The HPLC method was chromatographed with a mobile phase of methanol-0.02mol/L potassium dihydrogen phosphate solution (3∶7)，the sample was treated by adding 30% trichloroacetic acid to precipitate protein,and detected at 276mm.RESULTS:The average recovery of bioassay was within 95.90%～106.68%,the within-day and day-to-day precisions were below 6%.The average recovery of HPLC was within 97.24%～101.70%,the within day and day-to-day precisions were blow 5%.Lev tablets were given to 6 patients in two ways.Drug concentrations in plasma were determined by bioassay and HPLC assay,respectively,with no significant difference (P＞0.05).CONCLUSION:The bioassay was simple,cheap,time saving,and reliable.The HPLC method wsa rapid,sensitive,accurate.The two methods may be selected to use in actual conditions.

Objective To evaluate the effects of meglumine cyclic adenylate (MCA) pretreatment on acute lung injury (ALI) induced by lipopolysaccharide (LPS) in rats.Methods Fifty-four adult male Sprague Dawley rats,aged 2-3 months,weighing 200-250 g,were randomly divided into 3 groups (n =18 each) using a random number table:control group (group C),ALI group and MCA pretreatment group (group MCA).ALI was induced with LPS 10 mg/kg injected via the femoral vein in ALI and MCA groups.In group MCA,MCA 2 mg/kg was injected via the femoral vein at 20 min before LPS injection,while the equal volume of normal saline was given in C and LPS groups.Immediately before LPS injection and at 2 and 4 h after LPS injection,the blood samples were taken from the abdominal aorta for determination of PaO2,PaCO2 and plasma concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10).Six rats were sacrificed at 4 h after LPS injection and pulmonary specimens were obtained for microscopic examination of the pathological changes and for determination of cyclic adenosine monophosphate (cAMP) activity (by ELISA) and NF-κB p65 expression in nucleus (by Western blot).Results Compared with group C,PaO2 and cAMP activity in lung tissues were significantly decreased,and PaCO2,plasma concentrations of IL-10 and TNF-α and NF-κB p65 expression in nucleus in lung tissues were increased in group LPS.Compared with group LPS,PaO2,cAMP activity in lung tissues and plasma concentrations of IL-10 were significantly increased,and PaCO2,plasma concentration of TNF-α and NF-κB p65 expression in nucleus in lung tissues were decreased and the pathologic changes of lungs were attenuated in group MCA.Conclusion MCA pretreatment can attenuate ALI induced by LPS,and the mechanism is related to increased level of cAMP,activated cAMP signaling pathway,inhibited NF-κB activity and reduced inflammatory responses in lung tissues of rats.

Objective To study whether bortezomib combined with dexamethasone can relieve bone pain of patients with multiple myeloma and to see whether bortezomib have effect on bone metabolism through determining the concentration of bone turnover marks.Methods 59 cases of patients with multiple myeloma treated with BD and 38 cases of patients treated with VADM were observed before and after chemotherapy to compare the alleviation of bone pain,the improvement of the ability to move and the occurrence of skeletal related events between the two groups.The plasma from 25 patients were collected before and after chemotherapy when they were in hospital each time and the concentrations of TRACP-5b,BALP and DKK1 in plasma were determined by ELISA.Results BD group was better than VADM group in the rate of alleviation of bone pain,the improvement of the ability to move and the incidence of skeletal related events(75.7% vs 50%,64.9% vs 20.8% and 13.8% vs 57.8%,all P

Objective To evaluate the effects of dexmedetomidine on the oxidative stress responses during global cerebral ischemia-reperfusion (I/R) in rats.Methods Thirty-six male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 3 groups (n =12 each) using a random number table:sham operation group (group S),global cerebral I/R group (group I/R) and dexmedetomidine group (group D).Global cerebral ischemia was induced by occlusion of bilateral common carotid arteries combined with hypotension (MAP maintained at 35-45 mmHg).In group D,dexmedetomidine was infused at a rate of 3 μg · kg-1 · h-1until 2 h of reperfusion after a loading dose of dexmedetomidine 3 μg/kg was intravenously injected immediately after onset of reperfusion.The neurological deficit score (NDS) was assessed at 24 h of reperfusion,the rats were then sacrificed,and their brains were immediately removed for determination of cell apoptosis and levels of malondialdehyde (MDA),superoxide dismutase (SOD) and catalase (CAT).Apoptotic rate was calculated.Results Compared with group S,NDS,apoptotic rate and MDA level were significantly increased,and SOD and CAT levels were decreased in I/R and D groups.Compared with group I/R,NDS,apoptotic rate and MDA level were significantly decreased,and SOD and CAT levels were increased in group D.Conclusion Dexmedetomidine attenuates global cerebral I/R injury through inhibiting the oxidative stress responses.

This paper analyzed the system,methods,content,scope and standards of last two competition in order to further improve the clinical skills competition for national medical students in China.According to the characteristics of medical education,the paper proposed several opinions and suggestions as follows:repechage should be cancelled in competition system and objective structured clinical examination should be used in competition; the content,scope and criteria of the competition should take the actual ability of the medical students at graduation into consideration.