Objective: To investigate the impact of clopidogrel or aspirin resistance on major adverse cardiovascular events (MACE) in elderly patients with acute coronary syndrome (ACS) and to explore the application value of thromboelastogram (TEG) in antiplatelet therapy. Methods: A total of 177 ACS patients admitted in our hospital from 2012-09 to 2014-12 were enrolled. The patients were at the mean age of (70.4±10.7) years, all of them received TEG and coagulation function test. Based on the reaction of antiplatelet therapy, they were divided into 2 groups: Non-resistance group,n=98 and Resistance group,n=70, which was further divided into 2 subgroups as Maintenance dose subgroup,n=39 and Increased dose subgroup,n=40. The patients were followed-up for 3 months to observe MACE occurrence including cardiovascular death, angina recurrence, ischemic stroke, myocardial infarction, acute thrombosis and hemorrhage. Results: In Resistance group, there were 50/79 (63.3%) patients with aspirin resistance and 29 (36.7%) with clopidogrel resistance. Compared with Non-resistance group, Resistance group showed decreased coagulation time, clot formation time, TEG reducing rate after 30 minutes maximum amplitude (LY30), activated partial thrombin time (APTT), thrombin time (TT) and international normalized ratio (INR), allP<0.05; while increased levels angle, maximum amplitude of TEG, coagulationindex, ifbrinogen and D-dimer, allP<0.05. Compared with Non-resistance group, Resistance group had the higher MACE rate 21.5% vs 7.1%,P<0.05; in addition, Increased dose subgroup had the lower MACE rate than Maintenance dose subgroup 17.5 vs 25.6%,P<0.05. Conclusion: Clopidogrel or aspirin resistance had the higher incidence of MACE in elder ACS patients; TEG was helpful for guiding antiplatelet therapy and reducing MACE incidence.

Objective To study the follow-up value of MRI in the sequela hypoxic-ischemic encephalopathy(HIE).Methods MRI features of HIE in 81 neonates were analyzed retrospectively,every child had two cranial MRI scans,the first scan at the end of the newborn stage,the second scan at 4 months to 4 years.There were 66 full-term neonates and 15 preterm neonates.Results Of 81 cases,79 cases were abnormal on second MRI examination,including myelinogenetic abnormal in 59 cases(72.8%),external hydrocephalus(EH) in 53 cases(65.4%),brain malacia in 26 cases(32.1%),cerebaral atrophy in 25 cases(30.1%),white matter decrease in 24 cases(29.6%) and dysplasia of corpus callosum in 9 cases(11.1%).EH(26/35cases) and myelinogenetic abnormal(16/35 cases) in mild HIE group,brain malacia(12/29 cases) in moderate HIE group,cerebaral atrophy(16/17 cases) and white matter decrease(15 /17 cases)in severe HIE group were often seen.Conclusion MRI findings can reflect the pathological changes of sequela of HIE,and provide objective basis for diagnosis and assessment of prognosis.

Objective To investigate the status of wastewater treatment of hospital sewage in Jinan. Methods The indices of COD, NH3,N and PO43- in sewage discharged from 16 hospitals before and after treatment and the content of residual chloride and fecal coliform counts in treated sewage were monitored in 2002 in Jinan. The monitoring results were evaluated according to the Criteria for Wastewater Discharge (GB/T8978-1996) and compared with the analytic results obtained in the year 2001. Results The COD, NH3,N and PO43- of the sewage of 16 hospitals before treatment were 253.8, 47.76 and 3.134 mg/L respectively with the over standard rate 81%, 88% and 100% respectively. The COD, NH3,N, PO43-, content of residual chloride and fecal coliform counts in treated sewage of 16 hospitals were 40.5, 6.30, 0.580, 26.7 mg/L and

Objective To summarize the nursing experience in patients with CT-assisted thoracoscopic surgery for small indeterminate pulmonary nodules.Method The data of 26 patients having undergone CT-assisted thoracoscopic surgery for small indeterminate pulmonary nodules were analyzed retrospectively for summarizing the nursing experience.Result The CT-assisted locations of nodules and the thoracoscopic resection of the pulmonary nodules in all the patients were successfully performed,without pneumatothorax,haematothorax and pneumorrhagia.Conclusion Such measures as setting the right time for locating,enhanced management of body position,accurate and safe punctuation and well performance of surgical cooperation are all critical for the success of the resection.

Objective To study occupational hazards effects of electric welding,and evaluate protective measurements for different occupational hazards. Methods During 2008,occupational health services for 11 factories with shield carbon-dioxide arc welding work were provided,including surveillance of the work environment and surveillance of workers’health. Surveys of workers’health through various types of health examinations were carried out. Four hundred and thirty-three welding workers of 11 factories were included. Results The concentrations of 17 welding fume samples and 6 manganese dioxide samples were over the released limits of national standard,the maximum was 5.5,1.6 times of the limit respectively. The exceeding standard rate. of welding fume had positive correlation with the density of welding equipment(r= 0.72,P=0.01) and negative correlation with the ventilation area(r =-0.63,P =0.04) .The examination results showed that nobody suffered occupational diseases or occupational contraindications. Conclusion For the environmental risk factors existed in the electric welding operation site,more attention should be paid to the potentially occupational adverse effects of electric welding.

Objective The aim of this study is to provide guidance on rehabilitation nursing via observing the effect of comprehensive relaxation training on perioperative psychological stress in patients with coronary intervention treatment. Methods In this study, eighty patients ready to receive coronary intervention were randomly divided into the experimental group and the control group (40 patients in each). The control group were treated with routine percutaneous coronary intervention care, and the experimental group received both comprehensive relaxation training and routine care. The anxiety state and subjective feelings on comprehensive relaxation training in both groups were dynamically investigated via State-Trait Anxiety Inventory questionnaire and subjective feeling questionnaire from pre-operation to 7 days after operation. Results Anxiety levels between two groups showed the similar trend, and there was statistically significance between two groupsin the state anxiety level. The subjective feeling in the experimental group improved. Conclusions The psychological stress in patients receiving coronary intervention surgery maintains at high level form pre-operation to 24h post operation, and comprehensive relaxation training can significantly reduce the level of state anxiety. These patients consider that this simple training shows obvious relaxing effect.

Objective We aim to objectively evaluate the influence of six-character formula on patients with stable chronic obstructive pulmonary disease (COPD).Methods The randomized controlled trials (RCTs) which investigated the influence of six-character formula on patients with COPD were electronically searched in the databases such as China National Knowledge Infrastructure (CNKI),Chinese Science Technology Periodical Databases (VIP),Wanfang Data,PubMed,The Cochrane Library (Issue 6,2014) and ELSEVIER.According to the inclusion and exclusion criteria,the references was screened,the data were extracted and the methodological quality of the included articles was assessed.Then,Meta-analy-sis was performed using RevMan 5.3 software.Results A total of 10 studies involved,578 patients were included.The result of Meta-analysis showed that compared with the control group,six-character formula significantly improved six-minute walk distance,forced expiratory volume in a second (FEV1) and FEV1 predicted value,reduced the score of activity limitation and the impact of the disease in St George's respiratory questionnaire (SGRQ).the value of MD and 95％CI were 22.62 (10.49-34.75),0.10 (0.01-0.18),3.08 (0.18-5.97),8.69 (4.09-13.83),7.60 (2.34-12.85).However,there was no statistical difference in the score of symptom.Conclusions Six-character formula plays a significant role in the treatment of stable COPD.However,more studies in large scale and high quality are needed to verify the result.

Objective:To investigate the influence of different salt concentration on the renal fibrosis and macrophages infiltration in salt sensitive hypertension.Methods:Dahl salt sensitive rats were randomly divided into the normal salt (0.3 ％ nacl) group,4 ％ high salt,8 ％ high salt groups at six weeks continuously feeding for 8 weeks,each group contained 15 rats.Tail-cuffmethod was used to value rat blood pressure at 8 weeks,Masson trichromatic method was used to detect renal fibrosis of the three groups at 8 week.Immunohistochemistry and Western blot method were used to depict the renal macrophage infiltration at 8 week.Results:1) The blood pressure of 4 ％ salt and 8％ high salt group rats were significantly higher than those of the normal salt group at 8week,meanwhile the blood pressure of 8 ％ high salt was further increased than that of 4 ％ high salt group at 8 week.2) The relative kidney weight and renal fibrosis of 4 ％ salt and 8 ％ high salt group rats were obviously higher than that of normal salt group at 8week,meanwhile the relative kidney weight and renal fibrosis of 8 ％ high salt were further increased than those of 4 ％ high salt group at 8 week.3) The macrophage infiltration of 4 ％ salt and 8％ high salt group rats were higher than that of the normal salt group at 8week,meanwhile the macrophage infiltration of 8 ％ high salt was further increased than that of 4 ％ high salt group at 8 week.Conclusion:Different high salt concentrations had different effect on the renal fibrosis and macrophage infiltration in the salt sensitive hypertension,high salt concentration could exacerbate the renal fibrosis and macrophage infiltration.

Objective To analyze the diagnostic value of serum procalcitonin ( PCT ) for early postoperative bacterial infection after pediatric living donor liver transplantation.Methods A retrospective study was conducted in pediatric patients after living donor liver transplantation recipients admitted to department of critical care medicine of Beijing Friendship Hospital affiliated to Capital Medical University during June 2013 to October 2015.According to the clinical data , all pediatric patients were divided into infection group(n=60) and non-infection group (n=100).Primary disease, PCT post operation day 1 to day 5 for non-infection group and day 1 to day 9 for infection group , temperature , white blood cell , cold ischemia time, warm ischemia time, operation time, volume of blood loss during operation were recorded.All parameters above were compared between groups.Receiver operating characteristic ( ROC) curve was plotted, and the diagnostic value of PCT was evaluated.Results PCT of both groups were elevated after liver transplantation , there was a markedly resolution in non-infection group within 48 to 72 hours.PCT of pediatric patients with bacterial infection was significantly higher than that of non-infected patients , and the difference was of greatly significant (4.62 ±1.39) ng/ml vs (0.85 ±0.19) ng/ml,t=26.56,P=0.00.ROC curve showed that the peak level of PCT might be valuable in the diagnosis of bacterial infection ( AUC=0.985).There was no significant difference of cold ischemia time [(109.92 ±19.22) min vs (108.04 ± 13.20) min, t=1.05, P=0.29], warm ischemia time[(1.49 ±0.17) min vs (1.52 ±0.12) min, t=1.08, P=0.28], operation time[(8.01 ±0.77)vs (8.00 ±1.05) h, t=0.06, P=0.94], WBC[(8.95 ±1.69) ×109/L vs (8.98 ±2.00) ×109/L,t=-0.08, P=0.93]and body temperature[(37.5 ±0.7) vs (37.5 ±0.8) ℃,t=-0.05, P=0.96] on the first day after surgery between infection and non-infection groups.Amount of bleeding in infection group was higher than that of non infection group [ ( 650.87 ± 90.36) ml vs (240.29 ±67.67) ml, t=32.33, P=0.00], there was longer length of ICU stay in the infection group[(11.01 ±1.81)d vs (6.03 ±1.65)d, t=17.78, P=0.00].Conclusion Peak PCT level was a valuable indicator for early postoperative bacterial infection after pediatric living donor liver transplantation.

Purpose:To discuss the MRI features and differential diagnosis of hemangioblastomas in the central nervous system.Materials and Methods: The MRI features of 22 patients with hemangioblastomas confirmed histopathologically were analyzed retrospectively.Results: In this group there were 50 lesions in 22 patients.Multiple lesions were revealed in 5 cases.The lesions located in the cerebellar hemisphere and vermis ( n = 40),medulla oblongata and spinal cord ( n.= 9 ),cerebral hemisphere ( n = 1).Among the 50 lesions,12 appeared as a large cyst with mural nodule,36 as a solid mass,2 as a simple cyst.Of large cyst with mural nodule lesions,the content of the cyst was hy-pointense signal on T1WI,and hyperintense signal on T2WI.The mural nodules were slightly hypointense signal or isointense signal on Tl WI,and hyperintense signal on T2WI.The solid masses were isointense signal on Tl WI,slightly hyperintense signal and hyperintense signal on T2WI.On contrast enhanced scans,all mural nodules and solid tumors were showed marked homogeneous enhancement.On PWI the mural nodules and solid tumors were demonstrated marked hyperperfusion.Conclusion:Hemangioblastomas have distinctive manifestation,MRI enhanced scans and PWI play an important role in the diagnosis and differential diagnosis of hemangioblastomas.