OBJECTIVE:To study the mechianism of inhibitory effect of ulinastain on inflammatory factors of patients during cardiopulmonary bypass(CPB)cardiac surgery. METHODS:Totally 40 patients underwent selective CPB cardiac surgery collected from our hospital during Jul. 2012-Jul. 2016 were divided into control group and observation group according to random number ta-ble,with 20 cases in each group. Observation group was given 300000 U of ulinastatin at 2.5 mL/min by intravenous pump within 20 min after anesthesia induction, then given 700000 U of ulinastatin at 0.2 mL/min by continuous intravenous pump until opera-tion finish. Control group was given equal volume of normal saline. Blood samples of patients were collected before anesthesia in-duction (before surgery) and 6,12,24 h after CPB (after surgery),respectively. The expression of miR-155 and its target gene MyD88 in peripheral blood mononuclear cells of each group were detected by Real-time PCR and Western blot. The expression of TNF-α,IL-6 and IL-8 were measured by ELISA. The correlation of miR-155 with the expression of TNF-α,IL-6 and IL-8 in pa-tients of observation group 24 h after surgery were analyzed by using Pearson correlation analysis. RESULTS:Compared with con-trol group,the expression of miR-155 in observation group was significantly increased,while the expression of its target gene MyD88 was significantly decreased;the expression of TNF-α,IL-6 and IL-8 were reduced significantly,with statistical signifi-cance(P<0.01). The expression of miR-155 was significantly negative correlation with the expression of TNF-α,IL-6 and IL-8 in the patients of observation group 24 h after surgery(P<0.01). CONCLUSIONS:Ulinastatin can inhibit the release of inflammatory factors TNF-α,IL-6 and IL-8 by inducing the expression of miR-155,which may be a new mechanism for the anti-inflammatory ef-fect of the drug in CPB cardiac surgery.

Objective To evaluate the clinical value of fetal holoprosencephaly complicated with face malformation by two-dimensional(2D) and three-dimensional(3D) ultrasonography.Methods Fetal faces and brains were examined regularly with 3D ultrasonography when they were suspected abnormal with 2D ultrasonography and compaired the diagnoses with postnatal or induced delivery results.Results 11 cases of holoprosencephaly complicated with face malformation were diagnosed using 2D and 3D ultrasonography.Among these cases,there were 4 with single median mostril,2 with proboscis,2 with cheiloschisis,2 with multipte face malformation,1 with arhinia.They were all comfirmed by postnatal or induced delivery.Conclusions 3D ultrasonography provides visualized,three-dimensional,more precise and clearly fetal structure imagine.It has important supplement to 2D ultrasonography.2D ultrasonography combined with 3D ultrasonography can greatly enhance the diagnosis rate to holoprosencephaly complicated with face malformation.

ObjectiveTo study the mastery, acquiring ways and need of studying the knowl-edge and skill of emergency treatment in non- medical junior college and technical secondary school students. MethodsThe survey was carried out in 600 non-medical junior college and technical sec-ondary school students to investigate their mastery and need of emergency knowledge, the results underwent analysis. ResultsThe mastery of the emergency knowledge was uneven in non- medical junior college and technical secondary school students. 100.0% of them can call 120 correcdy, 58.5% of them mastered the e-mergency treatment of carbon monoxide poisoning, and 25.0% mastered cardiac pulmonary resuscitation. All the students desired to hold the knowledge and skill of emergency treatment. Television, broadcast and internet were the main ways for them to master emergency knowledge. ConclusionsThe mastery of the knowledge and skill of emergency treatment is not good. It is urgent to educate and train them with the knowledge and skill of emergency treatment, and to improve knowledge and skill of emergency treatment.

Objective To summarize the nursing experience in prehospital first-aid of patients with cardiac traumas in order to improve the cooperation capability of prehospital first-aid. Methods The nursing cooperation of prehospital first-aid of 33 patients with cardiac trauma was analyzed retrospec-tively. Results 24 cases of them were rescued successfully, and were completely recovered without se-quelas. 4 cases complicated with severe multiple trauma, died after arriving at hospital, and 3 cases com-plicated with multiple trauma died of complications, while 2 cases with injury of thoracic aorta died during the surgery. Conclusions Early emergency treatment and judgment of traumatic condition could pro-vide valuable chance for inhospital first-aid.

The purpose of this study is to explore the clinical application of an improved operating astral lamp. Most operating astral lamps now used in hospitals are not equipped with protective equipment for sudden power cut. Once the power cut occurs, the operation will be influenced and a medical dispute between patients and medical staffs can not be avoided.

Objective To assess the clinical efficacy and safety of endoscopic submucosal dissection(ESD) for submucosal tumor(SMT) of the gastrointestinal(GI) tract.Methods A total of 19 patients with SMT of the GI tract diagnosed by endoscopy(6 in the esophagus,6 the stomach,1 the duodenum,1 the sigmoid,and 5 the rectum),were examined using endoscopic ultrasonography(EUS).Among the cases,18 lesions were within the submucosa and 1 in the muscularis propria.The SMTs were managed by ESD with a needle knife.After injection of physiological saline solution into the submucosal layer to separate the lesion from the muscle layer,the mucosa surrounding the lesion was pre-cut,and the connective tissues of the submucosa beneath the lesion were dissected.Then,the lesion was resected completely.Results The resected lesions sized 0.5-3.0 cm in diameter(mean,1.6 cm).Among the 19 lesions,18 were successfully resected with ESD.The mean ESD procedure time was 45 min(ranged from 15 to 105 min).Two patients had massive hemorrhage during ESD,which could not be controlled under a gastroscope.One of them was treated with balloon compression,and the other was managed surgically.None of the patients had delayed bleeding after ESD.Perforation of the GI tract occurred in 2 cases(the duodenal ball in one,and the gastric fundus in another) during the procedure,and was closed with endoclips without surgical treatment.One patient with rectal carcinoid developed subcutaneous emphysema after the operation owning to deep tearing of the muscle layer,and recovered after several days' conservative treatment.Histological evaluation showed that the tunica of the tumors was intact,and both the lateral and basal margins of the specimens were free of tumor cells.Conclusions ESD is an efficacious and safe procedure for the treatment of SMT of the GI tract.It is possible to completely resect submucosal lesions and provide sufficient pathological information.For the SMT originated from the muscularis propria,ESD should be performed cautiously.

Objective To discuss the value of endoscopy in the diagnosis and treatment of Dieulafoy disease. Methods Twenty-one patients with upper gastrointestinal bleeding caused by Dieulafoy disease from June 1994 to June 2002 were analyzed retrospectively with regard to endoscopic features, therapeutic methods and outcomes. Results Of the 21 cases, diagnosis was confirmed in the first endoscopic examination in 15 cases (71.4%), and in two or more examinations in 6 cases. The bleeding was successfully stopped under endoscope in 17 cases: after the initial treatment in 14 cases (66.7%) and after the second treatment in 3 cases (14.3%), while the open surgery was required in 4 cases (19.0%). Conclusions Endoscopy is the alternative of the first choice in the diagnosis and treatment of Dieulafoy disease.

Objective To analyze the epidemic situation of human brucellosis in Qinghai Province,in order to provide a theoretical basis for prevention and treatment of the disease.Methods Xining city,Ping'an,Haiyan,Tianjun,Jiuzhi,Henan and Dari Counties were selected as monitoring counties(city) in Qinghai Province,and three or four townships(towns) were selected as monitoring points in each county.People aged from 6 to 60 closely contacted with livestock were monitored.The methods of rose bengal plate agglutination test(RBPT) and standard tube agglutination test(SAT) were used for serological testing.Results A total of 4 331 people from 6 counties and 1 city were examined for brucellosis,and 225 people (by RBPT) of them were serologically confirmed with a positive rate of 5.19％.SAT positive 63 people,the average positive rate was 1.45％.Two hundred and twenty-five people were infected and the average infection rate was 5.19％.Fifty-six new cases were discovered.Conclusion Human brucellosis has increased in Qinghai Province,effective prevention and cure should be adopted to prevent its outbreak.

Objective To assess the value of endoscopic submucosal dissection(ESD)for the treatment of early tumors located at the esophagogastric junction.Methods The clinical data of 57 patients with early tumors located at the esophagogastric junction who received ESD at the Zhongshan Hospital from November 2006to March 2011 were retrospectively analyzed.The operation time,blood loss,resection of tumor and perioperative complications were observed.The pre-and postoperative pathological findings were analyzed.Results ESD was successfully completed on the 57 patients.The median operation time was 55 minutes(range,25-95 minutes),and the median volume of blood loss was 74 ml(range,20-300 ml).En-bloc and piecemeal resections were carried out on 39 and 18 patients,respectively.The operative complication rate was 25%(14/57),including 5 patients complicated with perforation and 9 with bleeding.The postoperative complication rate was 16%(9/57),including 6 patients complicated with delayed hemorrhage and 3 with stricture of the esophagogastric junction.Of the 39 patients who were diagnosed as with high-level intraepithelial neoplasia preoperatively.3 were confirmed as with intramucosal carcinoma;of the 18 patients who were diagnosed as with intramucosal carcinoma preoperatively,4 were confirmed ag with adenocarcinoma.All patients were followed up for 9-27 months,no recurrence or metastasis was found.Conclusion ESD is effective and safe for the treatment of early tumors located at the esopha gogastric junction.

Objective To reflect the spatial distribution of brucellosis among 7 counties in Qinghai Province from 2011 to 2013 with Geographic Information System (GIS) map.Method Epidemiological situations were overlay analyzed in infectious rate and prevalence rate with QHEndemic-GIS and SPSS 17.0 by statistics and mapping.Results Brucellosis was detected in 7 counties through the spatial distribution map.The infectious rate and prevalence rate of brucellosis were showing a phenomenon of high and low alternation in 3 years;meanwhile the prevalence in Gonghe County showed an obviously upward trend with the rates of 0.50％ (1/201),1.50％ (3/200),and 3.73％ (9/241),respectively.Conclusions GIS could reflect the state of brucellosis infection directly and correctly.Prevalence of brucellosis in the 7 counties has showed a sporadic phenomenon,and the prevalence of brucellosis has covered a wide region and many populations are at risk of this disease.The prevalence has showed an up-ward trend in these regions,which provides a scientific basis for prevention and control of brucellosis in these key regions.