Objective To observe the incidence of orthostatic hypotension and hypertension in the elderly hypertensive inpatients and investigate the effect of antihypertensive medication on the orthostatic blood pressure changes in the elderly hypertensive inpatients.Methods A total of 185 aged hypertensive inpatients was divided into elderly group(n =126,60～79 years old) and very elderly group(n =59,≥80 years old) according to the age.The orthostatic blood pressure was measured in supine position and after standing.Subjects were divided into 3 subgroups:orthostatic hypotension (OH),orthostatic hypertension (OHT),and orthostatic normotension (ONT) groups according to the standing blood pressure levels.Clinical characteristics of each subgroup were evaluated and analyzed according to the antihypertensive medication.Results Among 185 patients,the OH incidence was 31 (16.76％) cases,the OHT incidence was 23 (12.43 ％) cases,and the ONT incidence was 131 (70.81％) cases.There were 16 (12.70％) patients with OH and 10(7.90％) patients with OHT in elderly group,but 15 (25.42％) patients with OH and 13 (22.03％) patients with ONT in very elderly group.The prevalence of OH and OHT in each elderly group was both higher than elderly group (P ＜ 0.05).Antihypertensive medications such as Calcium channel blockers,angiotensin Ⅱ receptor-blockers,Beta-blockers,diuretics,and angiotensin converting enzyme inhibitors were not significantly different among three subgroups.Conclusions OH and OHT were common in the elderly hypertensive inpatients,especially in the very elderly people.The five-class antihypertensive medication that doctors commonly used at present might be not related to the orthostatic hypotension and hypertension.

Objective To evaluate the accuracy of continuous noninvasive hemoglobin ( Hb ) monitoring in the patients undergoing cesarean section. Methods A total of 200 patients, at 36-42 weeks of gestation, aged 19-40 yr, with body mass index of 20.5-35.1 kg∕m2 , of ASA physical statusⅠorⅡ, undergoing elective cesarean section from June 2014 to October 2014 in our hospital, were enrolled. A sensor was positioned at patient′s finger and connected to the Masimo Radical?7 Pulse CO?Oximeter, a continuous noninvasive Hb measurement device. Noninvasive Hb obtained with Pulse CO?oximeter ( SpHb) was recorded. Before skin incision ( T0 ) , after delivery of the placenta ( T1 ) , after suturing the uterus ( T2 ) and at the end of operation ( T3 ) , blood samples from the radical artery were collected for determination of total Hb ( tHb) , and SpHb was also recorded. The agreement between two methods was assessed using Bland?Altman analysis. Results At T0-T3, tHb was 111±9, 103±8, 94±8 and (89±7) g∕L, respectively, and SpHb was 124 ± 9, 120 ± 12, 108 ± 9 and ( 103 ± 8 ) g∕L, respectively. Bland?Altman analysis showed that at T0-T3 , the mean difference between SpHb and tHb was 13.5, 17.1, 14.1 and 13.9 g∕L, respectively, and 95% confidence interval was 13.1-13.9, 16.5-17.7, 13.6-14.6 and 13.4-14.4 g∕L, respectively. The limit of agreement was 8.4-18.6, 9.1-25.1, 7.8-20.4 and 7.4-20.4 g∕L at T0-T3 , respectively, and the interchangeable limits of the two methods ranged between 3.5-23.5, 7.1-27.1, 4.1-24.1 and 3.9-23.9 g∕L at T0-T3 , respectively. The repeatability coefficient of tHb and SpHb was 16.5 and 15.8 g∕L, respectively. The relative error of SpHb was (4.6±1.0)%, (5.3±1.4)%, (4.9±1.2)% and (4.8±1.2)% at T0-T3, respectively. Conclusion Continuous noninvasive Hb monitoring provides good accuracy in the patients undergoing cesarean section.

This study was aimed to observe the effect ofJia-Shen prescription (JSP) on angiotensinⅡ (AngⅡ) inhibition, ventricular remodeling in myocardial infarction (MI) rat model. The anterior descending coronary artery of Sprague-Dawley rat was ligated to establish the MI rat model. Rats were randomly divided into the 3 g JSP group, 6 g JSP group, losartan group, model group, and the sham-operation group. Intragastric administration of medication was given 24 h after MI. In the 3 g and 6 g JSP group, JSP was given at the dose of 3 g·kg-1·day-1 and 6 g·kg-1day-1, respectively. Losartan was given at the dose of 10 mg·kg-1·day-1 in the losartan group. Same volume of distilled water was given to the sham-operation and model group. Four weeks later, the left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), posterior wall thickness (PWT), left ventricular ejection fraction (LVEF), left ventricular fractional shorten (LVFS), left ventricular weight index (LVWI), the distribution and content of collagen, plasma brain natriuretic peptide (BNP) and the AngⅡ content in myocardial tissues homogenate were observed. The results showed that 4 weeks after MI, compared to the model group, 6 g PJP reduced myocardial infarct size, LVWI, LVEDD and LVESD, and enhanced LVEF and LVFS (P< 0.05). In ischemic regions, compared to the model group, JSP can obviously reduce the content of collagen (P < 0.05). This effect had dose-dependent relationship. Plasma BNP and AngⅡ content in myocardial tissues homogenate were also obviously lower than the model group (P< 0.05). It was concluded that JSP can improve the ventricular remodeling of MI rat model. Its action mechanism may be through the AngⅡ inhibition, in order to improve the early stage left ventricular morphological remodeling, myocardial fibrosis and cardiac contractile function.

Objective The main objective of this study is to explore the effect of liver function on the awake BIS value.Methods According to the Child-Pugh classification,65 patients were divid-ed into three groups.Group A (n=27):patients with normal liver function;group B (n=21):pa-tients with Child-Pugh A;group C (n=1 7):patients with Child-Pugh B-C.The awake BIS value at rest was measured.Results Total bilirubin (TBIL),direct bilirubin (DBIL),indirect bilirubin (IBIL),alanine aminotransferase (ALT),aspartate aminotransferase (AST),albumin (ALB)of group B and C were significantly poorer than group A (P <0.05 or P <0.01).The coagulation func-tion of group C was poorer than group A and B (P <0.01).Compared with group A (96.2 ± 1.7) and group B (95.6±0.8),the awake BIS value of group C (94.1±3.0)was significantly reduced (P<0.01).The awake BIS value was negatively correlated with the TBIL value (r = - 0.26,P =0.039).Conclusion The awake BIS value in end-stage liver disease patients was significantly lower than that in patients with normal liver function and mild liver dysfunction.The awake BIS value may be related with the amount of total bilirubin in the blood.

Objective To investigate the distribution and drug resistance of major pathogens for urinary tract infections in the First Affiliated Hospital of Nanjing Medical University.Methods Strains from midstream urine culture of patients with urinary tract infections were collected during January 1 and December 31,2011.All strains were identified by API system,and disk diffusion method was used for drug sensitivity test.Results Totally 1129 strains were isolated,in which 667 (59.1％ ) were Gram-negative strains,266 (23.5％) were Gram-positive strains,and 196 (17.4) were Candida.Among Gram-negative strains,Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis were highly sensitive to carbapenem antibiotics; while Acinetobacter baumannii and Pseudomonas aeruginosa were highly resistant to most antibiotics including cephalosporins and penicillinase inhibitor,and the resistance rates were over 50％.Among Gram-positive strains,the major strains Enterococcus avium and Enterococcusfaecalis were completely sensitive to vancomycin and teicoplanin,and highly sensitive to linezolid (resistance rate below 10％ ).Candida albicans and Candida glabrata were highly resistant to voriconazole and fluconazole (with the resistance rates of 47.2％ - 60.0％ ), but were completely sensitive to amphotericin and nystatin.Conclusion Gram-negative strains account for most urinary tract infections in the First Affiliated Hospital of Nanjing Medical University with high drug resistance rates.

ObjectiveTo investigate the serum concentration of 25-hydroxy vitamin D [25(OH)D] in the second-trimester women in winter and explore its correlation with age and blood hemoglobin level. Methods The blood samples of 78 second-trimester women were collected during the 24-28 gestational weeks. Serum 25 (OH) D and blood hemoglobin levels were measured. The correlations of serum 25 (OH) D with age and blood hemoglobin levels were analyzed by Pearson correlation. ResultsOf the 78 pregnant women, the rates of vitamin D deficiency ( ≤25.0 nmol/L), insufficiency [25.0 nmol/L ＜ 25(OH) D≤50.0 nmol/L], and sufficiency were 65.38％, 30.77％, and 3.85％, respectively. Serum concentration of 25 (OH) D was positively correlated with blood hemoglobin level ( r =0.2746, P =0.015 ). ConclusionVitamin D deficiency or insufficiency is common among the second-trimester women in winter, especially among those with low hemoglobin level.

Objective To develop the method for simultaneous identification and quantification of morphine,6-monoactylmorphine,codeine,heroin,ketamine,3,4-Methylenedioxyamphetamine (MDA),3,4-methylenedioxymethamphetamine (MDMA),amphetamine and methylamphetamine in human plasma.Methods UPLC-MS/MS was adopted to analyze plasma with protein precipitated using 10％ trichloroacetic acid.Plasma samples were separated on ACQUITY UPLC HSS C18 column with aqueous solution (0.01％ formic acid)-methanol (0.01％ formic acid) as the mobile phase,and at a flow rate of 0.3 mL·min-1.The multiple reaction monitoring (MRM) mode was performed combined with the positive ion mode for quantification in four sections.Results The retention time,the characteristic fragment ions,and the relative abundance ratio of the molecular ion peak could be used to identify these nine compounds sensitively.The liner calibration curve of morphine,codeine,heroin,ketamine,6-monoacetylmorphine,MDA,MDMA,amphetamine and methamphetamine were obtained in the concentration range of 5.00×10-3～5.00 (r=0.9934),1.00× 10-2～ 10.00 (r=0.9905),1.00× 10-2～ 10.00 (r=0.9929),2.50× 10-3 ～2.50 (r=0.9960),5.00× 10-3 ～ 5.00 (r=0.9925),5.00× 10-4 ～ 5.00 (r=0.9910),5.00× 10-4 ～ 5.00 (r=0.9924),5.00× 10-4 ～ 5.00 (r=0.9920) and 5.00×10-4～5.00 μg·mL-1 (r=0.9900) respectively.The lowest detection limit was 1.00,1.00,1.00,0.50,0.50,0.10,0.10,0.10 and 0.10 ng· mL-1 respectively.The relative standard deviation (RSD) of the inter-day and intra-day were less than 18％.The relative recovery was more than 60％,and the RSD were less than 15％.Conclusion The method is accurate,sensitive and suitable for identification and quantification of 9 drugs of opiates,ketamine and amphetamines in human plasma.

Objective:To evaluate the effects of several kinds of surface treatment methods on the bond strength of zirconia prosthesis,and to provide references for improving the bond strength of zirconia prosthesis.Methods:Sixty zirconia blocks(10 mm×10 mm×2 mm) were divided into 6 groups according to the surface treatment methods:sandblasting,silica coating,Z-PRIME Plus,sandblasting+Z-PRIME Plus,sandblasting+silica coating,and silica coating+Z-PRIME Plus groups.The zirconia-resin specimens were fabricated using ScotchbondTM Universal;shear bond test was performed to detect the shear bond strength after treated with water storage(37℃) for 24 h by universal mechanical testing mechine;the fracture types were observed by stereoscopic microscope.One fracture specimen was randomly chosen from each group,and the morphology of the specimen was examined under scanning electron microscope.Results:The shear bond strength of the specimen in Z-PRIME Plus group was higher than those in the other groups(P<0.05).The adhesive failure was predominantly observed in sandblasting,silica coating,sandblasting+silica coating and silica coating+Z-PRIME Plus groups.There were 4 cases of mixed failure in Z-PRIME Plus group and there were 8 cases of mixed failure in sandblasting+Z-PRIME group.No cohesive failure was observed in all the groups.The scanning electron microscope results showed that the fracture surface occurred on the resin-zirconia interface of the specimens in sandblasting group,Z-PRIME Plus group,and sandblasting+Z-PRIME Plus group.The silica-zirconia fracture of specimens occurred in silica coating group and silica coating+Z-PRIME Plus group.The silica-resin interface fracture of specimens partially occurred in sandblasting+silica coating group.Conclusion:The application of Z-PRIME Plus can significantly improve the bond strength between zirconia and resin.

Objective To evaluate the efficacy of vitreoretinal surgery for the treatment of complicated rhegmatogenous retinal detachment and to study the correlated factors affecting the surgical outcomes. Methods Complete follow up data from 103 patients (eyes) with complicated rhegmatogenous retinal detachment treated with vitreoretinal surgery were analyzed retrospectively. Conditions of the eyes included macular hole in 21 eyes [with proliferative vitreoretinopathy (PVR) stage C2 or more serious in 12 eyes], giant hole in 11 eyes, and PVR stage C2 to D3 in 71 eyes. Filling with C3F8 was performed in 82 eyes, and silicone oil in 21 eyes. A follow up for 3-18 months was conducted. Results The reattachment of retina was achieved in 99 eyes (96.1%) and functional success in 68 eyes (66.0%). In eyes with functional success, visual acuity of 0.02-0.08 was achieved in 18 eyes, 0 1-0 4 in 39 eyes, 0.5-0.9 in 10 eyes, and 1.0 in 1 eye. Conclusion Vitreoretinal surgery is an effective way for the management of complicated rhegmatogenous retinal detachment. Early surgery may result in satisfactory surgical outcomes.

Objective To establish a proper internal quality control(QC) system for the automated hematology analyzer accord‐ing to the corresponding stipulation by ISO15189 :2012 .Methods The high ,normal and low levels of controls offered by the instru‐ment were used to detect 22 items in whole blood cells routine analysis ,draw the Levey‐Jennings chart ,analyze and evaluate the quality control data for each month or each batch .Results A proper QC system was established ,including quality goals setting , new QC target value and standard deviation calculating and the QC rules choosing .In setting the target value for new batch of con‐trol ,MCV ,HCT and MCHC should adopt the mean values of at least 20 values ,while other items could adopt the mean values of 10 values ;the difference of CV values for some items existed in different QC levels ,different brands or different instruments in the same brand .Therefore ,the quality goals and standard deviation for new batch should be set according to different levels and differ‐ent instruments .Due to the QC characteristics and existence of QC chart drift phenomenon ,therefore MCV ,HCT and MCHC should adopt the 13 s and 22 s rules .For the other items ,the 13 s ,22 s and 10x rules were adoted .Conclusion Under the corresponding stipulations of ISO15189 and by combining with the laboratory practical situation ,a set of applicable internal quality control system is established .