Objective To test the accuracy of American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for preoperative cardiovascular evaluation for noncardiac surgery in Chinese patients and to compare ACC/AHA guidelines with Goldman index and Lee index. Methods From January to December 2003, all patients aged ≥70 yr or patients aged 40-69 yr with a history of cardio- and cerebro-vascular disease, abnormal ECG or diabetes scheduled for noncardiovascular surgery were included in this study. A total of 1 248 patients were eligible. Their clinical data including demographic data, history of cardiovascular disease, routine physical examination and laboratory tests, the scheduled surgery and type of anesthesia were collected. The patients were then evaluated for cardiac risk and classified according to ACC/AHA guidelines (high, moderate, low and no risk), Lee index (class I -IV ) and Goldman index (class I - III ). The cardiac risk of the scheduled surgery was then stratified according to ACC/AHA guidelines. The patients were followed up until discharged from hospital. Cardiac events were defined as cardiac death, myocardial infarct, myocardial ischemia, minor myocardial cell injury, ventricular dysfunction and serious arrhythmia. Likelihood ratio of the 3 methods was calculated. Risk factors for adverse events were identified by univariate analysis and multivariate Logistic regression analysis. Results Of the 1 248 patients 694 were male and 554 female. Their age ranged from 40-102 years (mean age 65.4 yr). 44.7 % of the patients were aged ≥ 70 years. High risk operation accounted for 6.3 % and emergency operation 7.9% . One patients died of cardiac event and ten patients of other causes. Seventy-three perioperative cardiac events occurred in 53 patients. The morbidity rate was 4.2% . Goldman index and ACC/AHA cardiac risk stratification were correlated with adverse cardiac outcomes ( P

It expounded the important position of physique in etiology and process of disease,investigated essence and application of physique in disease control,revealed the classifi cation of physique in three yin three yang.Also it expounded the signif icance of diagnosis of disease in TCM theory and clinical therapy,then revealed basic pathogenesis of diabetes:damaged yin and qi due to inner heat.Then it discussed the syndrome differentiation in the TCM treatment and suggested that it should combine with physique differentiation and diagnosis of disease.At last it expounded the trinity of physique differentiation,diagnosis of disease and syndrome differentiation in treating diabetes and its complication.

To summarize current pathogenesis theories of diabetic nephropathy,focusing on kidney theory,spleen theory,collateral disease theory,toxicity injuring kidney meridian collaterals theory and micro-zhengjia theory.As for the study development,new research idea has been put forwards which highlights basic TCM syndrome study,clinical trial and experimental study,as it will improve the research works in this field.

In 2015 , policy reforms on centralized drug purchasing system have been released one by one , and the quality of medicines has been highly valued .Centralized drug purchasing system distinguishes different qualities of drugs mainly through bidding grouping , in order to achieve “uality priority”.However , there are yet some existing problems in group bidding policy at present , such as lack of a unified hierarchy , no scientific indicators and so on , which inevitably weaken the leading role of centralized purchasing policy over the quality of medicines .This paper , focuses on the study of group bidding , and the existing main problems are found through the statistical analysis of rel-evant policies introduced in different provinces .Finally, it explores some optimization strategies for “Group Bidding”which is of paramount importance .

Objective To evaluate the effect of immune enhanced enteral nutrition on immune function in postoperative patients with gastric cancer by using meta-analysis. Methods The databases of PubMed, the Cochrane Library, CNKI, CBM, VIP and Wanfang Data were used to search randomized controlled trials (RCT) about the effect of immune enhanced enteral nutrition and conventional enteral nutrition on immune function in postoperative patients with gastric cancer. The retrieval time span was from inception to Sept 1, 2016. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Besides, the meta-analysis was conducted by using RevMan 5.3 software. Results Meta-analysis included 5 RCT, 216 cases in total. The results showed that the immune parameters of immune enhanced enteral nutrition such as IgA (MD=0.18, 95 % CI 0.09-0.27, P< 0.001), IgG (MD= 0.76, 95 % CI 0.43-1.09, P< 0.001), IgM (MD= 0.13, 95%CI 0.07-0.20, P<0.001), CD3 (MD=4.74, 95%CI 2.99-6.48, P<0.001), CD4 (MD=3.6, 95%CI 2.14-5.06, P< 0.001), CD4/CD8 (MD= 0.58, 95 %CI 0.20-0.97, P< 0.003) were significantly higher than those of conventional enteral nutrition after 9 or 10 days of gastric surgery. The CD8 level of conventional enteral nutrition were higher than immune enhanced enteral nutrition after 9 or 10 days of gastric surgery (MD = -1.26, 95 %CI-2.21 - -0.30, P= 0.01). The difference between two groups had no statistical significance in immune parameters such as IgA, IgG, IgM, CD3, CD4, CD8, CD4/CD8 after 1 day of gastric surgery (P>0.05). Regarding to cellular factor, the IL-6 level of immune enhanced enteral nutrition was lower than conventional enteral nutrition after 9 days of gastric surgery (MD=-77.40, 95 %CI-112.25 - -42.55, P< 0.001). The difference between two groups enteral nutrition had no statistical significance about IL-6, TNF-αafter 1 day of gastric surgery, TNF-α, IL-2 after 9 days of gastric surgery (P> 0.05). Conclusion Immune enhanced enteral nutrition for postoperative patients with gastric cancer can improve and enhance the immune function under stress, and reduce the excessive inflammatory reaction, which is more conducive to the safety of patients with gastric cancer.

Objective To assess the association between serum γ-glutamyltransferase (γGT) levels and the risk of metabolic syndrome (MS),so as to provide a reference for prevention and diagnosis of MS.Methods Ten papers about the relationship between γGT level and incident MS published in Pubmed,Embase,and the Institute for Scientific Information (ISI),China Academic Journal Full-text Database,China National Knowledge Infrastructure Database and Wan Fang Digital Periodicals Database from January 2000 to April 2014 were retrieved and analysed.Results A total of 65 331 participants from the ten studies were included in the rmeta-analysis.The pooled RR was 2.06 (95％ CI 1.63-2.49) when the incidence of MS was compared between the highest and the lowest groups of γGT levels.A subgroup analysis was made in Asian and western populations.The pooled RR of MS in Asian population was 2.26 (95 ％ CI 1.65-2.87) and in western population it was 1.70 (95 ％ CI 1.15-2.25).Sensitivity analysis confirmed the stability of results.No publication bias was found in our meta-analysis by Egger's and Begg's test.Conclusion Current evidences from prospective studies indicate that risk of metabolic syndrome is increased in correlation with an increase in serum γGT,and serum γGT seems to be an important predictor for MS.

Objective To realize K space image reconstruction by using VC++ and Matlab in the development of MRI software.Methods VC++ called FFT(Fast Fourier Transform Algorithm) function of matlab math dlls to realize transforming the data from k space to real space.Results Image reconstruction was realized successfully for the clinical demand.The development circle and programming workload were greatly reduced.Conclusion The mixed programming by VC++ and Matlab can reduce the developing process and improve the reliability of the software.

Objective:To implement rapid acquisition gradient echo(RAGE)pulse sequence in clinical MRI scaner.Methods:Pascal language is engaged to edit source code.Number of slice excited,order of phase encoded,phase recycle of RF pulse,NEX,on/off of the gradients,and so on are all controlled by sequence parameters.SI×N_(phase)×N_(slice) data of 32 bctys were allocated to restore the k space.Source code of sequence was compiled with executable file and is loaded to RINMR software.Image of human brain are acquired.The experiment has been conducted on 0.36T permanent MRI system.Resuits:In the case of 256×256 matrix acquisition,time of single slice is 4 seconds.The resolution and SNR of the image are all adquately satisfy the clinical application.

Objective To investigate the diagnostic value of the ratio of % Micro to % Hypo in the diagnosis of three kinds of common thalassemia and iron‐deficiency anemia (IDA ) .Methods Forty‐nine cases of IDA ,24 cases of mildα‐thalassemia ,24 cases of mildβ‐thalassemia ,24 cases of silent α‐thalassemia and 120 individuals undergoing healthy physical examination were selected as the research subjects and divided into 6 groups:normal group ,IDA group ,mildα‐thalassemia group ,mildβ‐thalassemia group ,silentα‐thalassemia and mild thalassemia group(in duding mild α‐thalassemia group and mild β‐thalassemia group) .The % Micro and %Hypo were deteced in each group and their ratio was calculated .The results were performed the analysis and comparison .Results The % Micro/% Hypo ratio had statistical difference between the mild thalassemia group and IDA group ,between the mild thalasse‐mia and IDA group with the normal group(P<0 .01) .The% Micro/% Hypo ratio had no statistical difference between the silent α‐thalassemia group and normal group ,and between the mild α‐thalassemia group and mildβ‐thalassemia group (P>0 .05) .With the% Micro/% Hypo ratio of 0 .9 as the discriminant value to diagnose mild thalassemia and IDA ,its sensitivity ,specificity and accuracy for diagnosing mild thalassemia were 91 .67% ,91 .89% and 91 .72% respectively ,the sensitivity ,specificity and accuracy in diagno‐sing IDA were 91 .94% ,91 .25% and 91 .18% respectively .Conclusion The ratio of % Micro/% Hypo has good differential diagno‐sis and assisted diagnosis screening value ,but has little value for diagnosing silent α‐thalassemia .

Objective To discuss the selection of diagnosis for intracranial aneutysms,and to analyze thera-peutic efficacy of microsurgical treatment and endovascular embolizafion in the treatment of intracranial aneurysms.Methods 190 pailents suffeming from intracranial aneurysms experienced brain CT examination.37 cases detected by MRI.31 cases detected by MRA,134 were confirmed by computered tomographic angiography(CTA)or 3D-CTA,and 142 cases were confirmed by digital subtract angiography(DSA).96 patients underwent microsurgical treatment,4 of whom failed in endovascular embolization.92 cases underwent endovascufar therapy,2 of whom were embolized by ONYX,and the other were embolized by guglielmi detachable coil(GDC).Results 9 patients died,2 of whorn died of re-hemorrhage,3 died of severe vasospasm,4 died of pneumonia and other complications,and the others were cured.Conclusion CT is the first choice for the subarachniod hemorrhage;MBA could be a choice for the detection of intracranial aneurysm without hemorrhage,but is not suit for the aneurysm clipping.The size-form,relationship with patent arteries,and even the raptured point of aneurysms can be clearly demonstrated by CTA-and CTA can be used to the operation for intracranial aneurysms directly.DSA-especially 3D-DSA Call display the blood supply of the complicated aneurysms clearly,and can guide the treatment for intracnmial aneurysms directly.Endo-vascular therapy and aneurysm clipping seem like complimentary than competitive,patients with acute cerebral edema should try to undergo endovascular therapy,while the patients with severe vasespasm should be treated with microsur-gical operation immediately and resolutely.The ruptured aneurysms in multiple intracraniul aneurysm should be iden-tified correctly and treated in the early stage.