Objective To evaluate the cost-effectiveness of Morphine-midazolam, propofol and midazolam used for sedation in patients with mechanical ventilation. Methods Ninety-three patients with mechanically ventila-Morphine-midazolam group:priming dose 0.05 mg/kg and 0.05 mg/kg of morphine and midazolam,then continuous The index of ideal level of sedation was on the Ramsay scale. The sedation time, the time from discontinuation to ex-tubation, sedation costs, blood pressure were measured. Results The time in midazolam group (6.0±2.4) h was longer than that of propofol (4.6±1.7) h (P<0.01), but there was no significant relationship between morphine-midazolam group (5.6±2.7) h and midazolam group (4.6±1.7) h (P>0.05). The sedation costs in morphine-mi-dazolam group (101.7±20.4) yuan were lower than those of midazolam group (127.7±21.3) yuan (P<0.05) and propofol group(199.7±65.9) yuan (P<0.01). The ratio of hypotension in propofol group (35.4%, 11/31) hap-pened more frequent than that of midazolam group (3.2%, 1/31) (P<0.01) and morphine-midazolam group (9.7%, 3/31) (P<0.05). Conclusions Morphine-midazolam is a safe, effective and economic drug compared with midazolam and propofol used for sedation in patients with mechanical ventilation.

Objective:To investigate the correlation of serum hs-CRP,D-dimmer and Lp-PLA2 with vulnerable plaque of coronary artery atherosclerosis in patients with coronary heart disease.Methods:Selected 106 cases of patients in our hospital from January 2014 to December 2015,all taken coronary angiography and intravascular ultrasound.Divided into three groups according to the results of the examination,the levels of serum hs-CRP,D-dimmer and Lp-PLA2 were examined and compared,and the correlation with fiber cap thickness,plaque eccentricity index,and vascular remodeling index were tested by Pearson correlation analysis.Results:Serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group and stable plaque group were significantly higher than that of the control group (P＜0.05),and the serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group were significantly higher than that of stable plaque group (P＜0.05);hs-CRP was negative correlated with the thickness of fibrous cap (r=-0.712,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.813,0.756;D-,P＜0.05),D-dimmer was negative correlated with the thickness of fibrous cap (r=-0.654,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.912,0.853,P＜0.05);Lp-PLA2 was negative correlated with the thickness of fibrous cap (r=-0.796,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.836,0.729,P＜0.05).Conclusion:Hs-CRP,D-dimmer and Lp-PLA2 have high correlation with vulnerable plaque in coronary artery disease,can be used as reference indexes for assessing the instability of coronary atherosclerotic plaque.

Objective To compare the consistency of the results of clinical specimens between Tecan Freedom Evolyzer-2200 automated enzyme immunoassay analyzer and manual ELISA method,so as to explore more scientific and reliable test method.Methods Ninety samples were randomly selected from clinical and physical examination,the IMARK2 microplate reader and the instrument operating manual sample measurement was used to test hepatitis A,hepatitis B 5,hepatitis C,hepatitis E 2,TP and HIV,and the results were given correlation and linear regression analysis.Results For the test items of HBsAg,HBsAb,HBeAg,TP,HIV,the correlation coefficient was r2＞ 0.9,the data showed a good correlation,and for HAV-IgM,HBeAb,HBcAb,HCV,HEV-IgM,HEV-IgG,the correlation coefficient was 0.9＞ r 2 ＞ 0.6.Compared with manual method,the total coincidence rate of automated enzyme immunoassay analyzer was 96.9％ in 11 indexes of 90 samples.Conclusions Automatic and manual ELISA method has a good correlation.Automatic ELISA also greatly reduce the labor burden of laboratory personnel,improve efficiency,should be strengthened in clinical practice.

Objective To evaluate PICCO (pulse indicator continuous cardiac output) to predict fluid responsiveness in patients with acute lung injury secondary to septic shock.Methods We conducted a prospective study on 42 patients with acute lung injury secondary to septic shock.global end-diastolic volume index (GEDVI),pulse pressure variation (PPV),stroke volume variation (SVV),central vein pressure (CVP) and other haemodynamic data were recorded before and after fluid administration of 500 mL of 6％ hydroxyethyl starch.Responders were defined as patients with an increase in stroke volume index of at least 15％ after fluid loading.Performance of variables was analyzed using receiver operator characteristics analysis.Results GEDVI and PPV,but not SVV and CVP,were able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 1 hrs after admission to intensive care unit (ICU).The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.802,P ＜0.01) and PPV (AUC 0.752,P ＜0.01) ; the optimal cut-off of GEDVI and PPV were 643.5 mL/m2 and 13.5％,respectively.At this cut point,the sensitivity was 90.9％,the specificity was 91.9％,however,only GEDVI was able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 6hrs afteradmission to ICU.The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.788,P ＜ 0.01).the GEDVI ＜ 559 mL/m2 during loading were found to predict volume responsiveness with a sensitivity of 100％,specificity of 62.5％.Conclusions GEDVI and PPV predict fluid responsiveness in patients with acute lung injury secondary to septic shock in the early hours.

Objective To investigate the correlation between the prognosis and the early lactate clearance in patients with postcardiac surgery undergoing cardiopulmonary bypass.Methods The clinical data of 73 patients who underwent postcardiotomy undergoing cardiopulmonary bypass in SuBei Hospital of Jiangsu Provience,from March 2006 to February 2010,were prospectively collected and analyzed.The collection data including:( 1 ) Preoperative factors:including gender,age,diagnosis preoperative,NYHA grade,APACHE Ⅱ score and left ventricular end-diastolic diameter.(2) Operative factors:operation time,block aorta time.(3)Postoperation factors:hemorrhage volume,mechanical ventilation time,and factors of hemodynamics and oxygen metabolism at 6 hour postoperative:heart rate(HR),central venous pressure(CVP),pulmonary capilary wedged pressure( PCWP),cardiac output index( CI),arterial blood lactic acid,6 h lactate clearance,partial pressure of oxygen( PO2 ),mixed venous oxygen saturation ( SvO2 ),oxygen delivery index ( DO2I),oxygen consume index (VO2I),oxygen extraction ratio(O2ext).Patients were divided into survival group,control group,high level of lactate clearance group( lactate clearance rate ＞ 30％ ) and low level of lactate clearance group.Firstly,the data analyzed with process of single variable analysis and some parameters,which showed the significant difference,were sorted out from two groups.Then these parameters were put to the Logistic regression analysis.Consequently,the independent risk factors of death of postcardiac surgery could be found.Results The mortality in high lactate clearance group ( 4.55％ [ 2/44 ] ) was significantly less than the low lactate group (34.48％ [ 10/29] ) ( x2 =11.889,P ＜0.01 ).The single variable analysis had shown that there were significant difference on APACHE Ⅱ score ( [ 16.9 ± 2.9 ] vs [ 19.2 ± 2.6 ],t =2.537 ),left ventricular end-diastolic diameter( [ 53.9 ± 5.6 ] mm vs [ 63.8 ± 4.6 ] mm,t =5.847 ),block aorta time ( [ 101.2 ± 34.2 ] min vs [ 122.7 ±22.7 ] min,t =2.078 ),hemorrhage volume( [464.0 ± 158.8 ] ml vs [ 603.2 ± 159.5 ] ml,t =2.773 ),mechanical ventilation time( [ 22.6 ± 5.1 ] h vs [ 28.8 ± 5.2 ] h,t =3.857 ),arterial blood lactic acid ( [ 3.5 ±1.3 ] mmol/L vs [5.1 ± 1.5 ] mmol/L,t =3.912),lactate clearance ( [38.8 ± 17.4]％ vs [ 14.6 ±9.7]％,t =4.846),and SvO2( [69.1 ±4.2]％ vs [59.2 ±6.9]％,t =5.847) (P＜0.05 or P ＜0.001)between survival group and control group.Multiple regression analysis showed that lactate clearance and left ventricular enddiastolic diameter were the two independent risk factors of death,and the odds ratio(OR) were 7.773 (95％ CI 1.364-44.306,P ＜0.05) and 15.186(95％ CI 2.758-83.162,P ＜0.01).Conclusion Early lactate clearance rate can be used as an important indicator to evaluate the prognosis of patients with postcardiac surgery undergoing cardiopulmonary bypass.

A 61-year-old female presented with 4 years history of left-sided hemifacial spasm .Head MRI and angiography indicated left vertebral artery dissecting aneurysm which compressed ipsilateral cranial nerves Ⅶ and Ⅷ. Microvascular decompression was performed .The dissecting aneurysm was pushed apart and the distal part of the parent artery was adhered to the dura on the petrosum .The compressed nerves were totally decompressed .The symptom of facial spasm was completely resolved immediately after surgery and did not recur during 6 months of follow up .

From November 2014 to July 2017,637 patients with acute coronary syndrome (ACS) were included in the analysis,among whom there were 48 cases with prior ischemic stroke (7.5％).The risk factors,history,severity of coronary artery disease,medication status,and incidence of adverse cardiovascular and cerebrovascular events (cardiac death,re-infarction,heart failure,stroke) were analyzed.Compare with patients without prior ischemic stroke (control group) patients with prior ischemic stroke (study group) had lower rates in administration of beta blockers [50.00％(24/28) vs.69.78％(411/589),x2=8.02,P＜0.05]and interventional therapy[56.67％(17/30) vs.81.86％(334/408),x2=11.15,P＜0.05].However,there were no significant differences in medication of dual antiplatelet,statins and angiotensin converting enzyme inhibitors or angiotensin receptor blocker between two groups (P＞0.05);and there was no significant difference in major adverse cardiovascular events between two groups (P＞0.05).In the future,more studies are needed for clinical management of this group of patients.

Objective:To detect the expression of ALG3 in human bladder cancer and analyze its clinical significance.Methods:Bioinformatics was conducted to analyze the mRNA level of ALG3 in bladder cancer tissues and normal tissues, and to analyze the relationship between its expression and the survival rate of bladder cancer patients. The clinical and pathological data of 87 patients with bladder cancer who underwent surgical treatment were retrospectively analyzed. Immunohistochemical method was used to detect the expression level of ALG3 protein in bladder cancer tissues and healthy tissues adjacent to the cancer, and to analyze its relationship with clinicopathological characteristics of bladder cancer patients.Results:The results of bioinformatics analysis showed that ALG3 mRNA was highly expressed in bladder cancer tissues, and was significantly correlated with the overall survival rate and disease-free survival rate of patients. Immunohistochemical results showed that ALG3 was mainly localized in the cytoplasm and was highly expressed in bladder cancer tissues, but low or no expression in healthy tissues adjacent to the cancer. The high expression of ALG3 in bladder cancer tumor tissue was related to tumor stage and tumor recurrence (all P<0.05), but not related to age, gender, tumor grade and lymph node metastasis (all P>0.05). Conclusions:ALG3 plays an important role in the occurrence and development of bladder cancer, and it is expected to become an important therapeutic target and prognostic marker for bladder cancer.

Objective:To detect the expression of CCNB2 in human renal clear cell carcinoma and analyze its clinical significance.Methods:Bioinformatics was conducted to analyze the mRNA level of CCNB2 in renal clear cell carcinoma tissues and normal tissues, and to analyze the relationship between its expression and the survival rate of renal clear cell carcinoma patients. The clinical and pathological data of 98 patients with renal clear cell carcinoma who underwent surgical treatment were retrospectively analyzed. Immunohistochemical method was used to detect the expression level of CCNB2 protein in renal clear cell carcinoma tissues and healthy tissues adjacent to the cancer, and to analyze its relationship with clinicopathological characteristics of renal clear cell carcinoma patients.Results:The results of bioinformatics analysis showed that CCNB2 mRNA was highly expressed in renal clear cell carcinoma tissues, and was significantly correlated with the overall survival rate and disease-free survival rate of patients. Immunohistochemical results showed that CCNB2 was highly expressed in renal clear cell carcinoma tissues, but low or no expression in healthy tissues adjacent to the cancer. The high expression of CCNB2 in renal clear cell carcinoma tumor tissue was related to tumor stage and tumor size (all P<0.05), but not related to age, gender and tumor grade (all P>0.05). Conclusions:CCNB2 plays an important role in the occurrence and development of renal clear cell carcinoma, and it is expected to become an important therapeutic target and prognostic marker for renal clear cell carcinoma.

Objective To study the correlation between aldosterone/renin ratio (ARR) and heart rate variability (HRV),QT interval in patients with essential hypertension.Methods A total of 179 people were divided into two groups according to median number of ARR,and 24 h Holter,24 h ambulatory blood pressure,ECG,serum potassium,serum sodium were monitored,then HRV and QT interval index were compared between the two groups.Results There were significant differences between the two groups in SDNN,SDNN index,SDANN index,RMSSD,QTc,blood potassium,sodium (P ＜ 0.05),while gender,age,diabetes,smoking,BMI,average heart rate,heart rate standard deviation showed no significant difference.At the same time,correction factors showed that ARR was still negatively correlated with SDNN,SDNN Index,SDANN Index,RMSSD,serum potassium (r =-0.444,-0.677,-0.381,-0.623,-0.432,P ＜ 0.05),andwaspositivelycorrelated with QTc,serum sodium (r =0.391,0.379,P ＜ 0.05).Multivariate logistic regression analysis showed that SDNN,SDNN Index,SDANN Index were the independent factors related to ARR (P ＜0.05).Conclusion High aldosterone is closely related to heart rate variability reduction.