Objective To investigate the clinical application of pulse indicator continuous cardiac output (PICCO) target oriented role monitoring technique on hemodynamics in patients with intractable heart failure.Methods Eighteen patients with intractable heart failure were selected as control group and received regular treatment including internal medicine under monitoring by central venous pressure.Another 18 patients with refractory heart failure were selected as PICCO group and given the internal medicine under PICCO monitoring.Intrathoracic blood volume index(ITBVI),global end diastolic volume index(GEDVI),extravascular lung water index (EVLWI),cardiac index (CFI),N-terminal B type natriuretic peptide precursor(NT-proBNP) and left ventricular ejection fraction(LVEF) were recorded.The data including mortality rate,ventilation time,intensive care time,APACHE Ⅱ score and the re-hospitalization rate were also record at 28th day.Results Compared with before treatment,ITBVI,GEDVI,EVLWI in PICCO group were (1 282.6 ± 196.4) ml/m2,(1 026.8 ±92.1) ml/m2,(12.9 ± 5.5) ml/kg respectively,significant different from that before treatment ((907.4±78.3) ml/m2,t =8.75,P =0.001; (715.2 ±61.8) ml/m2,t =6.48,P =0.003; (6.5 ± 1.2)ml/kg),t =2.94,P =0.033) and they are all back to normal level.The indices of CFI,NT-proBNP,LVEF in PICCO group were improved than before treatment (CFI:(3.1 ±0.5) L/min vs.(4.8 ± 1.3) L/min,t =2.56,P=0.042) ;NT-proBNP:(6 438.3 ±249.5) ng/L vs.(1 371.6 ±87.5) ng/L,t =5.12,P =0.019) ;LVEF:(26.9±3.1)％ vs.(54.3 ±2.5)％,t =2.62,P =0.040)).Mortality at 28th D in PICCO group was 16.7％,lower than that of control group (33.3％,x2 =4.99,P =0.026).The indices of assisted ventilation time,intensive care time,APACHE score of lⅡ and the rehospitalization ratein PICCO group were better than that of the control group ((8.5 ±2.3) dvs.(3.2±0.8) d,t=24.31,P＜0.05;(14.9±2.3) dvs.(8.3 ±2.0)d,t=12.26,P=0.002;(23.4±1.3) vs.(14.7±1.6),t=9.52,P=0.011;38.9％ vs.11.1％; t=5.79,P =0.020).Conclusion PICCO provides effective guidance for intractable heart failure patients hemodynamic monitoring of goal orientation.

Objective To explore the expression of matrix metalloproteinase-3 (MMP-3) and matrix metalloproteinase-10 (MMP-10) in normal endometrium, atypical hyperplasia and endometrial adenocarcinoma. We aimed to study the relationship of MMP-3 and MMP-10 expressions with infiltration depth, histologic grade and clinical phase in order to explore the role of MMP-3 and MMP-10 in the occurrence, infiltration and metastasis of endometrial adenocarcinoma. Methods The expressions of MMP-3 and MMP-10 were measured by immunohistochemistry in 12 cases of normal endometrium, 12 cases of atypical hyperplasia and 42 cases of endometrial adenocarcinoma. Results The expression of MMP-3 was 73.8% (31/42), 25.0% (3/12) and 8.3% (1/12) in endometrial adenocarcinoma, atypical hyperplasia and normal endometrium, respectively, whereas the expression of MMP-10 was 76.2% (32/42), 33.3% (4/12) and 0(0/12), respectively. Both MMP-3 and MMP-10 expressions exhibited a pattern of decreased intensity in endometrial carcinoma, atypical hyperplasia and normal endometrium. Furthermore, the statistical analysis showed that the expression of both proteins was significantly greater in endometrial carcinoma than in atypical hyperplasia and normal tissue (P<0.01). Expressions of MMP-3 and MMP-10 had a significant correlation with such clinical parameters as histologic grade, depth of myometrial infiltration and clinical stage (P<0.01). Conclusion MMP-3 and MMP-10 can be used as tumor markers of endometrial carcinoma, and the combined detection of them can increase the detection rate of endometrial carcinoma.

Objective To explore the causes,clinical manifestations,diagnosis and treatment method of femoral artery pseudoaneurysms (IFPSA) after ultrasound-guided percutaneous coronary intervention.Methods Ultrasound-guided repair by compression was applied to all cases,of which the failed cases were treated with ultrasound-guided thrombin injection.Results IFPSA was confirmed by ultrasound imaging in 39 cases,18 of which were cured by compression repair,with the average compression duration of (36.78 ± 1.71 )min.Another 21 cases were cured by the thrombin injection,after compression repair failed,with average time for thrombosis (0.33 ± 0.06 )min.All the patients were re-evaluated by ultrasound 24 h after treatment,confirming the successful closure of the pseudoaneurysms.No recurrence of pseudoaneurysm was observed during a half-year post-operative follow-up.Conclusion Ultrasound-guided compression repair and ultrasound-guided thrombin injection into the cavity are safe and effective treatments for femoral arterial pseudoaneurysms after coronary intervention.

Background As one of the most common microvascular complication of diabetes in eyes,diabetic retinopathy (DR) is one of the most important cause of blindness.Nuclear factor-kappa B (NF-κB) is involved in the occurrence and development of the disease through the activation of a series of inflammatory cytokines.Objective The present study was to investigate the effects of peroxisome proliferator-activated receptor-gamma (PPAR-γ) excitomotor,rosiglitazone,on NF-κB expression and apoptosis of the retinal ganglion cells (RGCs) in the retina with diabetes mellitus. Methods Ninety SPF male Wistar rats were randomized into normal control group,diabetic control group and rosiglitazone group.Diabetes mellitus was induced by intraperitoneal injection of 50 mg/kg streptozotocin(STZ).Then 3 mg/kg rosiglitazone was intragastricly administered once per day in the rosiglitazonegroup,and the same volume of saline solution was used at the same way in the normal control group and diabetic control group from 3 days after modeling.The rats were sacrificed and the eye cups specimen was made at 4,8 and 12 weeks after usage of drugs.Retinal histopathological examination was performed by hematine-eosin staining,and expression of NF-κB p65 protein in retina and apoptotic index(AI) of RGCs were detected by immunohistochemistry and TUNEL assay,respectively in different time points mentioned above.The use of the animals complied with the Regulations for the Administration of Affairs Concerning Experimental Animals by State and Technology Commission.Results The blood glucose level was significantly elevated at various time points in the diabetic control group and rosiglitazone group compared with normal control group (P＜0.01 ),and that of the rosiglitazone group was significantly declined in comparison to the diabetic control group (q =0.81,0.82,1.23,P＞ 0.05 ).Normal retinal structure was seen in the normal control group,and edema retinal cell and disorder of retinal layers were exhibited in the diabetic control group.Retinal structure was almost normal in the rosiglitazone group.The NF-κB p65 was expressed weakly in the retina of normal control group,but the expression of NF-κB p65 was significantly elevated in the diabetic control group and rosiglitazone group compared with the normal control group(P＜0.01 ).However,the expression of NF-κB p65(A value)was significantly decreased in the rosiglitazone group compared with diabetic control group at 8 weeks and 12 weeks( q=17.77,15.30,P＜0.01 ).There were a few apoptotic cells in rat retina of the normal control group.Compared with the normal control group,the AI of the diabetic control group and rosiglitazone group was significantly reduced(P＜0.01 ).However,the AI of RGCs in the rosiglitazone group was significantly lower than that of diabetic control group in various time points (q =19.28,27.39,49.92,P＜0.01 ). Conclusions As one of the PPAR-γexcitomotors,rosiglitazone can inhibit apoptosis of RGCs through downregulating the expression of NF-κB in rat retina with diabetes mellitus,indicating a protective effect of rosiglitazone on retina in diabetic rat.

Objective To investigate clinical characteristics and related factors of ulcerative colitis (UC).Methods One hundred and thirty-seven newly diagnosed patients with UC from 2006 to 2009 in the People's Hospital of Xinjiang Uygur Autonomous Region were selected as our subjects.The clinical data were recorded and the patients were followed up for 3 years.Results Of 137 patients,complete remission rate was 38.69％ (53/137),and partial response rate was 61.31％ (84/137).The overall effective rate was 100％ (137/137).The 1-year cumulative relapse rate was 26.28％ (36/137),and 2-year cumulative relapse rate was 49.64％ (68/137),59.85％ (82/137) for 3-year cumulative relapse rate.The occasion rate (≤ 1 time/year)was 27.01％ (37/137),and frequency (≥2 times/year) was 32.85％ (45/137).Fifty-five patients (40.15％ (55/137)) were no recurrence within 3 years.Relapse rate were not relate to gender (P ＞0.05).The relapse rate of patients less than 50 years was 68.09％ (64/94) substantially higher than that over 50 age group (41.86％ (18/43),x2 =8.444,P ＜ 0.05).The relapse rate of Uygur patients (70.42％,50/71) was substantially higher than the Han (48.48 ％ (32/66),x2 =6.851,P ＜ 0.05).The relapse rate of left colon and extensive colon were 71.64％ (48/67) and 71.88％ (23/32),higher than that of rectum(28.94％,11/38) (P＜ 0.05).The relapse rate of severe group (82.61％,19/23) was higher than that of the mild (52.38％,33/63)and moderate groups (58.82％,30/51) (P ＜ 0.05).In maintenance of mitigation group,52.73％ patients (29/55) were received maintenance treatment and relapse of those patients were significantly higher than recurrence group (31.71％,26/82,P ＜ 0.05).Mental stress may be the top one risk factor,which lead to recurrence of UC (64.63％,53/82),followed by imbalance diet (56.10％,46/82) and overwork (39.02％,32/82).Conclusion Relapse rate of the Uygnr UC patients was higher than that of the Han,and young adults has the higher recurrence rates than the elder.The factors of lesion extent,severity,ability to maintain treatment are related to recurrence of UC.Stress,imbalance diet and overwork are risk factors of recurrence of UC.

Objective Study on cytochrome P450 (CYP) 2C19 gene single nucleotide polymorphism and the clinical prognosis of coronary heart disease (CHD) patients with percutaneous coronary intervention (PCI) after long-term use of clopidogrel.Methods A total of 150 cases of CHD patients was chosen prospectively between January 2013 and June 2014 who were hospitalized and PCI.All patients accepted dual antiplatelet therapy.Platelet aggregation rate and platelet aggregation inhibition rate were detected before taking the medicine and after PCI,which were used to classify the patients into clopidogrel-resistance groups (CR) and non-clopidogrel-resistance group (NCR).CYP2C19 gene single nucleotide polymorphism type was determined.The patients in CR group accepted clinical intervention countermeasures and NCR group was used as control,and postoperative recurrence angina and bleeding at the one year of operation were observed.Results About 24.67％ of patients with CHD with clopidogrel treatment,platelet aggregation rate cannot recover to normal.The correlation analysis showed CYP2C19* 2 carriers had a significantly higher platelet aggregation rate.Comprehensive analysis found that CYP2C19 * 2,long-term smoking,increased platelet count,and diabetes were the independent risk factors that platelet aggregation rate cannot recover to normal.No significant differences were found in primary end point,secondary end points,and bleeding events between CR group after clinical intervention countermeasures and NCR group.Conclusions CYP2C19 * 2,long-term smoking,increased platelet count,and diabetes are the independent risk factors that platelet aggregation rate cannot be developed to standard.Patients with clopidogrel resistance,the clinical intervention countermeasures to strengthen antiplatelet therapy can improve high platelet reactivity after PCI in CHD patients,and does not increase the risk of bleeding.

Abstract? AIM: To evaluate the efficiency of two different operation ways, vitrectomy and vitrectomy combined with inferior scleral buckling, for a complex kind of retinal detachment.?METHODS:The complex kind of retinal detachment were diagnosed in 100 cases ( 100 eyes ) , with the common features:1)the course of more than 1mo;2) at least one retinal hole located in the inferior marginal retina;3) the detachment of retina was found proliferated, there was at least 1 retinal fold in retinal detachment area. The patients were randomly divided into two groups: the treatment group ( 50 eyes ) who received vitrectomy combined with inferior scleral buckling;the control group ( 50 eyes ) who received vitrectomy without scleral buckling. The retinal anatomic reattachment, visual function recovery, macular central fovea thickness and complications in two groups were observed.? RESULTS: There were 49 eyes ( 98%) with retinal anatomic reattachment in the treatment group while 42 eyes(84%)in control group(χ2=4.2605, P<0.05);the best corrected visual acuity ( BCVA) was 0.254 ±0.238 in the treatment group while it was 0.219±0.229 in control group (t=1.8879,P>0.05);the macular central fovea thickness was 272 ±32.21μm in the treat group while it was 316 ± 33.46μm(t=12.597,P<0.01).Intraocular pressure in 12 eyes ( 24%) was more than 30mmHg in the treatment group while 4 eyes ( 8%) in control group within 1wk postoperation (χ2=4.7619,P<0.05); intraocular pressure in 100 eyes were controlled below 21mmHg 1mo postoperatively.? CONCLUSION: It is a more effective method to vitrectomy combined with inferior scleral buckling than the single vitrectomy for the special kind of retinal detachment.It can increase the rate of retinal anatomic reattachment and reduce macular edema.

Objective To explore the characteristics of cesarean scars pregnancy(CSP)and discuss differ-ent therapeutic methods and clinical outcomes. Methods Clinical data of 96 cases of CSP were collected from Sep-tember 2013 to October 2016 and patients′ clinical features,intra-operative findings,β-HCG,vaginal bleeding duration,hospital stay and cost and effects of different treatments were recorded and analyzed. Results The types of CSP were the determinant of lesion resection ,followed by the tumor size and blood β-HCG levels. The cases of uterine lesion resection and general uterine curettage with UAE had less blood loss than those without UAE. The cases of uterine lesion resection had short hospital stay and those with general uterine curettage had longer vaginal bleeding duration. Conclusion TVCD and MRI have important values in the diagnosis of CSP. During the treatment of CSP,personalized treatment planning,early diagnosis and treatment exert influence on reducing complications.

Objective To evaluate the value of colposcopy screening independently for cervical lesions in basic hospitals.Methods A retrospective cohort study of 574 patients who both underwent colposcopy and had pathologic results in our department.The consistency,authenticity and predictability of colposcopy and pathological results,the relevant factors affecting the accuracy of colposcopy diagnosis,and the analysis of unsatisfactory colposcopy results were analyzed.Results Agreement between colposcopic diagnosis and cervical pathology was 50.57％,and Kappa value of consistency was 0.358 (P ＜ 0.01).Agreement within one grade was 91.38 ％ (Kappa value was 0.871,P ＜0.01).The sensitivity of colposcopy in diagnosing of low-grade squamous intraepithelial lesion (LSIL) and above was high (96.91％),while the specificity was 52.60％ (81/154);False positive rate was 47.40％,and false negative rate was 3.09％.The sensitivity of colposcopy in diagnosing of high-grade squamous intraepithelial lesion (HSIL) and above was 81.82％ (153/187),and the specificity in diagnosing of LSIL and below was 90.68％ (146/161);False positive rate was 9.3％,and false negative rate was 18.2％.The stage of cervical cancer and skills of colposcopist would be factors that influence the accuracy of colposcopy screening in HSIL and above (P ＜0.01).Average age in unsatisfactory colposcopy was (52 ± 9) y,which was significantly different from satisfactory colposcopy cases (P ＜ O.O1).The proportion of early cervical lesions in patients with unsatisfactory colposcopy HSIL or above was high.Conclusions The complete coincidence rate between colposcopy and pathological diagnosis is limited,but the consistency within one grade is good;the stage of cervical lesions and the experience of examiners are the factors related to the accuracy of colposcopy in diagnosing HSIL and above lesions;Unsatisfactory colposcopy cases can be further combined with cytology and HPV examination for shunt and treatment.

Objective To study the effect of pre-hospital and in-hospital integrated rescuing pathway on group injury treatment in high-altitude areas.Methods According to pre-hospital and in-hospital integrated rescuing pathway,24 cases of group wounded were treated with field evaluation,triage category,emergency care measures,specialist nursing,monitoring during transfer,in-hospital first aid,processing during and after operation,and effect of clinical treatment.Results There were 7 cases of combined injury,12 cases of debridement surgery and 5 cases of damage control surgery in this group,with the successful rate of 100％.Conclusions rofessional pre-hospital and in-hospital integrated rescuing pathway in high-altitude areas can provide ordered rescuing for group wounded and shorten the time without treatment,which is an important measure to ensure fast and efficient treatment and to improve the quality of nursing.