Objective To compare the effect of ticagrelor and clopidogrel on platelet functions and inflamma-tion factor in patients with acute coronary syndrome(ACS)after PCI.Methods 180 patients with ACS who taken PCI were chosen and randomly divided into the observation group and the control group(90 cases in each group).All patients of the two groups were given conventional treatment,and the control group received clopidogrel treatment on the basis of routine therapy preoperation and postoperation,while the observation group received clopidogrel treatment on the basis of the control group treatment.Before treatment and 24 h,7 d,28 d after treatment,the C-reactive protein (CRP),interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),myeloperoxidase(MPO),soluble CD40 receptor (sCD40L),platelet maximum aggregation rate(MPAR)and P2Y12 response unit(PRU)in the two groups were recorded and compared,as well as the main cerebrovascular events after six months follow-up.Results In the two groups before treatment,MPAR and PRU had no statistically significant differences(t=0.41,0.19,all P>0.05). 24h,7d and 28d after operation,MPAR and PRU were significantly decreased compared with before treatment(t≥2.09,all P<0.05).MPAR in the observation group were (53.24 ±11.20)%,(42.33 ±10.80)%,(30.77 ± 8.99)% respectively,which were significantly lower than those in the control group[(57.34 ±13.21)%,(48.09 ± 10.90)%,(38.87 ±8.97)%](t=2.24,3.56,6.05,all P<0.05).24h,7d and 28d after operation,PRU in the observation group were (214.56 ±13.45)U,(190.57 ±12.21)U,(113.26 ±10.90)U respectively,which were significantly lower than those in the control group[(225.59 ±14.78)U,(210.21 ±14.09)U,(143.23 ±12.01)U] (t=5.24,2.11,17.53,all P<0.05).In the two groups before treatment,CRP CD40L,IL-6 and TNF-αhad no statistically significant differences(all P>0.05 ).24h after treatment,CRP,sCD40L,IL-6 and TNF-αin the two groups all significantly increased(all P<0.05),and then decreased.24h,7d,28d after treatment,DCRP,sCD40L,IL-6 and TNF-αin the observation group were all significantly lower than those in the control group (t=60.79, 50.30,27.95,12.98,40.29,16.73,15.03,7.30,all P<0.05).And,the incidence rate of cardiovascular adverse events of the observation group was 2.22%,which was significantly lower than 10.00% of the control group(χ2 =5.714,P<0.05).Conclusion Compared with clopidogrel,using ticagrelor to treat ACS patients after PCI has better antiplatelet aggregation and inflammation effects,which can reduce the incidence of cardiovascular adverse events.

Objective To compare clinical effect and complications of micro-implant anchorage(MIA ) or self -driven titanium implant(SDIA) with headgear anchorage in treatment of maxillary dentoalveolar protrusion .Methods 50 patients with maxillary dentoalveolar protrusion were selected and divided into observation group and control group .Each group contained 25 patients .14 patients in observation group received MIA treatment while 11 patients received SDIA treatment .All patients in control group re-ceived headgear anchorage treatment .Comparison was made in respects of course of treatment ,clinical effect and complications .Re-sults The course of treatment in observation group was (19 .85 ± 2 .01) months while in control group was(23 .58 ± 1 .79) months . The treatment time in control group were longer than observation group (P < 0 .05) .U1-SN angle in observation group were de-creased(16 .8 ± 1 .9)° while the control group decreased(20 .2 ± 2 .1)° .In the vertical direction ,the observation group maxillary inci-sor and first molars were shorten (2 .0 ± 0 .8)mm and(1 .6 ± 1 .0)mm respectively ,while the control group were shorten (0 .7 ± 0 .5) mm and(0 .3 ± 0 .7)mm .In the sagittal direction ,the observation group maxillary first molars were moved (0 .6 ± 1 .1)mm while the control group were moved (1 .7 ± 0 .8)mm .The difference of U1-SN ,U1-X ,U6-Y ,U6-X between two group were statistically sig-nificant .The comparison of expulsion rate between MIA and SDIA had no statistical significance .But the rate inflammation symp-tom and hyperplasia of the gum in SDIA patients were higher than MIA patients .Conclusion MIA and SDIA had better ability in treatment of maxillary dentoalveolar protrusion in vertical direction than headgear and improve the curative effect of maxillary den -toalveolar protrusion and both of them had same fell off rate ,but SDIA had higher rate of inflammation .

Objective To investigate the change of intracellular cholesterol lipid metabolism and related gene expression after vascular smooth muscle cells infection by human cytomegalovirus(HCMV).Methods By separating the primary umbilical artery vascular smooth muscle cells with a multiplicity of infection of HCMV attack as the experimental group and the control group a-dopted the DMEM/F12 medium containing 3% bovine serum for simulating infection.The change of cholesterol content in the smooth muscle cells after virus attack was detected and the gene expression gene was detected by the gene expression profiling chip method.Results After vascular smooth muscle cells were infected by HCMV,the intracellular gene expression changed significant-ly,in which low-density lipoprotein receptor-related protein 10,11,12 and HMG-CoA synthase,HMG-CoA reductase and B scaven-ger receptor were upregulated.Apolipoprotein A1 and apolipoprotein M were downregulated.Conclusion HCMV infecting vascular smooth muscle cells may alter the lipid metabolism pathway related gene expression,enhance intracellular cholesterol synthesis,re-sult in the cholesterol metabolism imbalance,thus participate in the pathogenesis process of atherosclerosis.

Objective To evaluate the indications, effectiveness and complications of vitreoretinal surgery using the 25G transconjunctival sutureless vitrectomy system (TSV25G) under the topical anesthesia. Methods The clinical and follow-up data of 22 eyes of 22 patients undergone vitreo-retinal surgery using TSV25G under the topical anesthesia were retrospectively analyzed. All of the patients were monocular sickened, including idiopathic macular hole in 10 eyes, idiopathic macular pucker in 6, vitreoretinal traction syndrome in 4, and vitreous hemorrhage associated with branch retinal vein occlusion in 2. Peeling of epiretinal membrane and/or internal limiting membrane, intraocular laser coagulation, air-fluid exchange and tamponiding of C 3F 8 were performed according to the condition of diseases. The postoperative follow-up was 1-11 months, with the mean duration of 6.4 months. The effect of analgesia, cooperation with the patients, operative effect and complications in and after the surgery were observed. Results The operations finished successfully in all of the eyes under the topical anesthesia. The operation duration ranged from 20 to 25 minutes with average of 22 minutes. The patients cooperated with the doctor well without any discomfort. Two days after the surgery, edema of the wounded conjunctiva was found, and recovered 7 days later. A light pigment dot on the surface of the sclera could be seen at the first month. The complications included transient increasing of intraocular pressure in 2 eyes, feather-like opacity of lens in 5 eyes, vitreous hemorrhage in 1 eye, and air-bleb under conjunctiva in 2 eyes. No other complications related with the cut were found. The macular hole closed in 9 eyes with idiopathic macular hole, and the other 1 had the smaller but not closed hole. Idiopathic macular pucker, vitreoretinal traction syndrome, and vitreous hemorrhage associated with branch retinal vein occlusion were cured successfully. Conclusions Vitreoretinal surgery using the TSV25G under the topical anesthesia has many advantages such as simple procedure, short operation time, micro-invasion, less complications and rapid revovery, and mainly serves simple manipulation in some simple diseases such as idiopathic macular hole, vitreo-retinal traction syndrome, and simple hemorrhage.

Objective To investigate the value of spectral CT for the discrimination of benign and malignant lung lesions through multi-parameter quantitative measurement.Methods Eighty-one patients who had lung nodule or mass on X-ray or plain CT were scanned using spectral CT,generating iodine concentration,water concentration and 101 sets of monochromatic images.Iodine concentration,water concentration,spectrum energy curve and CT value at 40 keV were measured with spectral post-processing software.70 eligible patients were divided into pneumonia group and tumor group.ANOVA analysis was used for the statistic analysis in two groups.Results The iodine concentration in pneumonia group and tumor group were (1.47 ± 0.17) and (0.77 ± 0.19) g/L (F =203.97,P ＜ 0.05).The slope rates of spectrum energy curve in pneumonia group and tumor group were 1.65 ± 0.27 and 0.88 ± 0.22 (F =161.59,P ＜0.05).The CT values at 40 keV in pneumonia group and tumor group were (139.00 ± 16.25) and (83.29 ± 17.44) HU (F =160.45,P ＜ 0.05),there were significant differences in iodine concentration,slope rates and CT values at 40 keV between two groups.The water concentration in pneumonia group and tumor group were (1021.56 ± 11.68) and (1022.62 ±8.56) g/L (F=0.19,P＞0.05),there was no significant difference.Conclusion Spectral CT technique has very important value for the discrimination of benign and malignant lung lesions.

Objective To evaluate the efficacy and safety of Qijialifei capsule,a kind of Chinese traditional medicine,as adjuvant chemotherapy for retreatment patients with smear positive pulmonary tuberculosis.Methods One hundred and sixty retreatment cases with smear positive pulmonary tuberculosis were divided into observation group (80 cases) and control group (80 cases).All patients received the therapy of 3SHRZE/6HRE.The patients in observation group took Qijialifei capsule.Then comparisons were made between two groups in the sputum tubercle bacillus conversion rate,focus improvement rate,cavity closing rate,the cellular immune function,and clinical symptom improvement.Results In 160 cases,77 cases in observation group and 78 cases in control group completed the treatment.At the end of intensified therapy period and at the end of the whole therapy the sputum tubercle bacillus conversion rate [79.2％ (61/77),92.2％ (71/77)] in observation group were significantly higher than those in control group [64.1％ (50/78),78.2％ (61/78)](P ＜ 0.05).The focus improvement rate,cavity closing rate in observation group [74.0％(57/77),26.0％(20/77)] were significantly higher than those in control group [52.6％ (41/78),11.5％ (9/78)] (P ＜ 0.05).At the end of intensified therapy period,the focus improvement rate,cavity closing rate in observation group [92.2％ (71/77),54.5％ (42/77)] were significandy higher than those in control group [76.9％ (60/78),29.5％ (23/78)] (P ＜ 0.05).By the end of the whole therapy,the number of CD3+,CD4+,CD4+/CD8+ of patients in observation group were significantly higher than those in control group (P ＜ 0.05).The disappearance of clinical symptoms in observation group was shorter than that in control group(P ＜ 0.05).The rate of side effects on Qijialifei capsule was only 1.3％(1/77).Conclusions Qijialifei capsule can improve the cellular immune function of the patients,can effectively alleviate the symptoms and can improve the sputum tubercle bacillus conversion rate,radiographic focus improvement rate and cavity closing rate.It is safe.

With high incident of cancer and chronic disease, it is more and more important to develop palliative care; as developing later, there is neither unified palliative care mode and related policy, nor mature assessment collaboration in China. It pointed out that Australia as an advanced country with stable development of palliative care and assessment collaboration, called palliative care outcomes collaboration (PCOC). It expatiated the PCOC on structure,function and operation. China should learn from the mode of Australia palliative care assessment and management collaboration, find references to improve and further develop Chinese palliative care assessment collaboration.

Objective To investigate the current status of health education among nursing undergraduates,to analyze the existing problems and to bring up corresponding strategies for improving the health education ability for nursing undergraduates.Methods Totally 381 nursing undergraduates were recruited and investigated with a self-designed questionnaire.Aspects of students' cognition of health education,influencing factors of health education and the implementation of health education in clinic were investigated.Data were processed using SPSS 12.0 and percentages were calculated.Resuits 98.75％ students understood the importance of heath education in nursing work.However,systemic training courses of health education for nursing undergraduates were insufficient in both colleges and hospitals.Meanwhile,clinical teachers' ability of health education was limited.Only 15.59％students provided health education for patients independently.Conclusions Nursing colleges and practicing hospitals should strengthen health education consciousness of nursing undergraduates,enhance faculty construction and should set up related courses to train the health education skills.

Objective To investigate curative efficacy of ginkgo biloba extract dripping pills in treatment of acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI) and its effects on platelet aggregation rate(PAR), activated clotting time(ACT) and antithrombin(AT)Ⅲ. Methods 90 patients of ACS treated with PCI who received therapy from January 2014 to October 2016 in Zhejiang green town cardiovascular hospital were selected and randomly divided into the observation group and the control group , 45 cases in each group.The control group was treated with routine treatment after PCI, while the observation group was combined with ginkgo biloba extract dripping pills.After treatment of seven days, the changed of PAR, ACT, ATⅢ and adverse cardiovascular events were compared, after treatment three months, the seattle angina scale were compared. Results After treatment, the levels of PAR in the observation group were significantly lower than that of the control group, and the levels of ACT and ATⅢ were significantly higher than that of the control group, the difference was statistically significant (P<0.05), the total incidence of adverse cardiovascular events in the observation group was significantly lower than that of the control group , the difference was statistically significant ( P<0.05), in the seattle angina scale, the scores of stable state of angina pectoris, the attack of angina pectoris, physical activity limitation, treatment satisfaction in the observation group were significantly better than that of the control group, the difference was statistically significant (P<0.05). Conclusion Ginkgo biloba extract dripping pill is well for ACS after PCI, which can effectively relieve clinical symptoms, to improve the expression of PAR, ACT and ATⅢ, helps to reduce the incidence of adverse cardiovascular events.

Objective To explore the factors associated with delayed defecation in long-term ventilated patients in intensivecare unit (ICU) and their potential effect on prognosis.Methods A prospective observational cohort study was conducted. The patients admitted to general ICU of the Affiliated Hospital of Qingdao University from October 1st in 2013 to September 30th in 2015 who underwent mechanical ventilation (MV) for ≥6 days were enrolled, and they were divided into early defecation group (< 6 days) and late defecation group (≥6 days). At admission, clinical nutritional support were given as usual, and gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, admission reasons, MV reasons, the usage of morphine and epinephrine/norepinephrine, the highest positive end-expiratory pressure (PEEP), the lowest oxygenation index (PaO2/FiO2) and the lowest systolic blood pressure were collected. Logistic regression analysis was used to analyze the influencing factors of the first defecation time. ICU mortality, the length of ICU stay, central venous catheter (CVC) indwelling time, duration of MV, ICU acquired bacterial infection rate, and the incidence of ventilator associated pneumonia (VAP) were compared between early defecation group and late defecation group. Logisticorgan dysfunction system (LOD) scores and gastric residual volume per day were recorded at the different time of MV.Results Totally 189 patients were enrolled, 39 patients did not satisfied the inclusion criteria and 13 patients gave up treatment or referrals were excluded. Finally 137 patients were enrolled in the analysis, 83 patients in late defecation group and 54 in early defecation group. There were no significant differences in the baseline characteristics such as gender, age, APACHE Ⅱ score, LOD score at 1 day of MV, admission reasons, MV reasons, disgorging and gastric residual volume per day during the first 5 days of MV, enteral nutrition, lactulose treatment in patients with hepatic encephalopathy during the first 5 days of MV, and blood purification treatment between the two groups (allP > 0.05). Compared with the early defecation group, late defecation group had less patients with loose stools or watery stool at first time [15.7% (13/83) vs. 33.3% (18/54)], more patients using morphine and the usage of epinephrine/norepinephrine more than 24 hours [48.2% (40/83) vs. 40.7% (22/54), 42.2%(35/83) vs. 29.6% (16/54)], higher the maximum PEEP level [cmH2O (1 cmH2O = 0.098 kPa): 7.9±3.7 vs. 6.7±3.5], lower the minimal systolic blood pressure [mmHg (1 mmHg = 0.133 kPa): 74.8±28.1 vs. 88.9±30.2] and more severe of hypoxemia [PaO2/FiO2 < 150 mmHg, 54.2% (5/83) vs. 44.4% (24/53)], all of which had significant differences (allP < 0.05). Factors found statistical significances by single factor analysis were enrolled in the multiple regression analysis, which showed that PaO2/FiO2 < 150 mmHg and systolic blood pressure < 90 mmHg were independently associated with a delay in defecation in patients undergoing long-term MV [PaO2/FiO2 < 150 mmHg: adjusted hazard rate: 1.415, 95% confidence interval (95%CI) = 1.061-1.590,P = 0.026; systolic blood pressure 70-89 mmHg:HR = 1.461, 95%CI = 1.164-1.788, P = 0.002; systolic blood pressure ≤ 69 mmHg: adjusted hazard rate= 1.273, 95%CI = 1.010-1.587,P = 0.034). ICU mortality, the length of ICU stay, CVC indwelling time, duration of MV, ICU acquired bacterial infection rate, and the incidence of VAP at 7 days of MV in late defecation group were significantly higher than those of early defecation group [ICU mortality rate: 15.7% (13/83) vs. 7.4% (4/54), the length of ICU stay (day): 17.0 (14.0, 23.0) vs. 15.0 (13.8, 20.0), CVC indwelling time (days): 12.0 (10.0, 14.0) vs. 10.0 (9.0, 11.3), duration of MV (days): 14.0 (10.0, 20.0) vs. 11.0 (9.8, 15.3), ICU acquired bacterial infections rate: 60.2% (50/83) vs. 14.8% (8/54), the incidence of VAP: 32.5% (27/83) vs. 14.8% (8/54); allP < 0.05]. There was no significant difference in LOD score between both groups. The LOD scores at 4 days and 9 days of MV in late defecation group were significantly higher than those of early defecation group (6.41±4.37 vs. 5.21±3.12, 4.33±2.20 vs. 3.50±2.90, bothP < 0.01).Conclusions PaO2/FiO2 < 150 mmHg and systolic blood pressure < 90 mmHg during the first 5 days of MV were independently associated with a delay in defecation in patients undergoing long-term MV. The results suggest that constipation is associated with adverse outcomes in long-term ventilated patients.