Objective To discuss the effect of two different warming methods on the circulation of free flaps during operation and seek for an optimal warming method which is benificial for the circulation of free flaps, and thus provide clinical evidences for intraoperative care. Methods A total of 96 patients undergoing free flap transplantation were divided into routine warming group and diversification warming group randomly (n=48 each). In routine warming group, temperature in the operating room was set at routine temperature and flaps were douched by routine heated saline. In diversification warming group, the temperature in the operation room, fluids used for washing wounds and flaps were warmed, fluids for intravenous application were pre-warmed by a fluid warmer, in addition, the operation table where patients were lying on was covered with warmer blanket. The influence of two different warming methods on the circulation of free flaps was observed. Results The scores of flap elasticity and capillary refill time in routine warming group were 2.02 ± 0.79 and 2.04 ± 0.81, respectively, vs. 2.50 ± 0.61 and 2.48 ± 0.6 in diversification warming group, showing diversification warming group was statistically better than routine warming group (Z=1.949, 3.872, P<0.05). In addition, the flap survival rate in routine warming group was 81.2%(39/48) vs. 95.8%(46/48) in diversification warming group, showing significantly better results in diversification warming group (χ2=4.02, P < 0.05). Conclusions The diversification warm keeping method can effectively promote the circulation and survival of flaps, improve clinical prognosis, accelerate postoperative rehabilitation, therefore is worthy of being recommanded its clinical application.

Objective:To discuss the relationship between the geographic environment and blood urea nitrogen(BUN) reference values of the healthy people,and to explore the distributional rule of BUN reference values of the healthy people,and to provide the scientific foundation for establishing the BUN reference value standards of different areas.Methods:A total of 23 geographic factors and 33 521 BUN reference values of healthy adults measured by 403 medical facilities from 23 provinces,4 municipalities and 5 autonomous regions were collected.The spatial autocorrelation analysis was used to determine the spatial autocorrelation of the sample data;the correlation analysis was used to detect the factors which correlated significantly with the BUN reference values;the multiple linear regression,principle component analysis and ridge regression analysis were respectively used to construct the predicted models;the paired-sample t test was used to choose the optimal model;the distribution map of BUN reference values was built by geostatistic analysis.Results:There were 5 geographic factors,latitude(X2),altitude(X3),annual mean temperature(X5),annual mean relative humidity(X6) and annual precipitation(X7),correlated significantly with the BUN reference values.The regression equation of optimal model was Y^=5.112+0.000 127 1X2+0.000 094 61X3-0.000 140 5X5-0.000 136 8X6-0.000 139 1X7±0.531 0;the distribution map of predicted values of the BUN reference values was obtained.Conclusion:The overall trend of BUN reference values is low in the east and high in the west.The BUN reference value is negatively associated with the altitude.If the geographic data of a certain region could be obtained,the BUN reference value of this region will be predicted.

This research focused on the doctors' changes based on the performance-payment reform from a district public hospital of Chongqing.The work compared the doctors' work efficiency,medical quality,scientific research,new technology and new project,cost control and patients burden.Performance-payment reform significantly activated doctors' self-study initiative and quality.The main running quotas of hospital,including stuff's positivity,work efficiency,medical quality,scientific research,new technology and new project,presented a better improvement trend.This not only reduced the patient cost burden,relieved the doctor-patient relationship,but also improved the hospital personnel cohesion,and strengthened the core competitiveness of the hospital.

Fibroblast growth factor-21 (FGF-21) is an important metabolism regulator, however, whether FGF-21 has effects on cardiovascular remains unclear. In this study, H2O2-induced injury in H9c2 cells was used as a cell model, the anti-apoptosis potential and mechanism of FGF-21 against oxidative injury were evaluated by MTT assay, flow cytometry assay and real-time PCR. The results showed that FGF-21 could increase the cell survival of H2O2-induced injury in H9c2 cells and prevent H9c2 cells from oxidative stress-induced apoptosis. Furthermore, FGF-21 can elevate SOD activity and regulate Bcl-2/Bax expression in H9c2 cells. The results suggest that FGF-21 have protective effect against the H2O2-induced apoptosis in H9c2 cells.
Animals ; Apoptosis ; drug effects ; Cell Proliferation ; drug effects ; Cells, Cultured ; Fibroblast Growth Factors ; pharmacology ; Hydrogen Peroxide ; toxicity ; Malondialdehyde ; metabolism ; Myocytes, Cardiac ; cytology ; drug effects ; metabolism ; Oxidative Stress ; drug effects ; Protective Agents ; pharmacology ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; metabolism ; RNA, Messenger ; metabolism ; Rats ; Reactive Oxygen Species ; metabolism ; Superoxide Dismutase ; metabolism ; bcl-2-Associated X Protein ; genetics ; metabolism

Thirty SHRs were obtained randomly to hypertension, model group, captopril group and Qingre jiangya capsule group. Ten Wistar rats were used as control group. The hippocampus tissue was removed to explore the damage of spontaneously hypertensive rats (SHR) and the protective effect of Qingre jiangya capsule after continuously administered for 14 days. And then the data were processed by principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). The research results revealed captopril group was significantly different from the other three groups. The classification of other three groups is also very clear after captopril group removed. This suggested that Qingre jiangya capsule could improve the overall metabolism compared with captopril. Four metabolites were identified: dimethylglycine, glycerophosphocholine, aldosterone and noradrenaline. Hypertension hippocampus damage may mainly be expressed in tyrosine metabolism, aldosterone-regulated sodium, vascular smooth muscle contraction reabsorption, and Qingre jiangya capsule could reverse the hippocampus tissue damage of SHR.
Animals ; Capsules ; pharmacology ; Drugs, Chinese Herbal ; pharmacology ; Hippocampus ; drug effects ; Hypertension ; drug therapy ; Male ; Rats ; Rats, Inbred SHR ; Rats, Wistar

Objective: To evaluate clinical features with in-hospital and long-term prognosis of acute myocardial infarction (AMI) in patients ≤40 years of age by different genders and to analyze the predictors for major adverse cardiovascular event (MACE) occurrence. Methods: A total of 685 AMI patients ≤40 years treated in our hospital from 2012-01-01 to 2015-08-31 were consecutively enrolled. The patients were divided into 2 groups by gender: Male group,n=650 and Female group,n=35. The baseline data, clinical features, in-hospital MACE incidence were collected by telephone communication and compared between 2 groups; the long-term risk factors for MACE occurrence were analyzed. Results: The AMI ratio in male patients was 94.89%, in female was 5.11% and the onset age in Male group was higher than Female group (35.53±4.21) years vs (34.05±4.98) years,P=0.046. Compared with Female group, Male group showed the lower rates of coronary left main diseases (3.2% vs 11.4%,P=0.012) and in-hospital heart failure (8.3% vs 25.7%,P=0.001). The median follow-up time was of 727.0 (411.5, 1102.0) days and during that period, MACE occurrence rates in Male group was 46 (7.1%) cases and in Female group was 2 (5.7%) cases,P=0.758. Increased level of hs-TnI, (OR=1.003, 95% CI 1.001-1.006,P=0.020) and multi coronary artery disease (OR=1.964, 95% CI 1.018-3.790,P=0.044) were the independent predictors for long- term adverse event occurrence; while PCI (OR=0.475, 95% CI 0.241-0.936,P=0.031) was the protector for long-term prognosis in young male AMI patients. Conclusion: AMI patients≤40 years were mainly in male gender, the mean onset age in male was elder than female. Increased hs-TnI level and multi coronary artery disease were the predictors for MACE occurrence, while PCI was the protective factor for long-term prognosis in young male AMI patients.

Objective To systematically review the efficacy and safety of postoperative radiotherapy and postoperative chemotherapy for patients with endometrial cancer,which may give support for clinical proper selection.Methods The randomized controlled trials (RCTs)comparing postoperative radiotherapy with post-operative chemotherapy for patients with endometrial cancer were searched in EMBase,PubMed,Cochrane Library,Chinese Biomedical Literature Data,China National Knowledge Infrastructure,and VIP database from the inception to August 201 5.Two reviewers independently assessed the quality of included studies and extrac-ted data.We analyzed the statistic data using RevMan 5.1 software.Results Three RCTs concluding 1 1 21 patients were included.Meta analysis showed that there were no significant differences between the two groups in five-year survival rate (RR =0.94,95%CI:0.80-1 .1 0,Z =0.77,P =0.440),five-year progression-free survival rate (RR =0.98,95%CI:0.90-1 .07,Z =0.52,P =0.61 0)and recurrence rate (RR =1 .06, 95%CI:0.91 -1 .24,Z =0.75,P =0.450),but there were significant differences between the two groups in grade 3-4 thrombocytopenia (RR =0.1 3,95%CI:0.07-0.27,Z =5.62,P <0.000 01 )and grade 3-4 neu-tropenia (RR =0.01 ,95%CI:0.00-0.03,Z =8.27,P <0.000 01 ).Subgroup analysis showed that there were significant differences between the two groups in five-year survival rate (RR =0.79,95%CI:0.68-0.91 , Z =3.1 5,P =0.002)and five-year progression-free survival rate (RR =0.82,95%CI:0.69-0.97,Z =2.31 ,P =0.020)for patients with Ⅲ-Ⅳ stage endometrial cancer.Conclusion Current evidence indicates that compared with postoperative radiotherapy,postoperative chemotherapy may improve the survival rate for pa-tients with advanced stage endometrial cancer.The long-term curative effects still need to be confirmed by RCTs with high quality and large sample.

AIM:To study the effects of water decoction of Platycladus orientalis on reducing high blood glucose and lipids in diabetic and hyperlipidemia nice,respectively.METHODS:The mouse model of hyperlipidemia was established.The increasing rate of weight, hepatic index, lipid content of liver and atherosclerosis index (AI) were meas-ured.Blood levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), adiponec-tin (ADP) and interleukin-6 (IL-6) were detected.According to these indexes, the function of water decoction of Platy-cladus orientalis for reducing high blood lipids caused by hyperlipidemia was evaluated .At the same time, the model of dia-betes mellitus was established .The levels of fasting plasma glucose , fasting plasma insulin and blood tumor necrosis factor-α( TNF-α) were measured .The glucose tolerance test was performed .The insulin resistance index was calculated .The function of water decoction of Platycladus orientalis to reduce high blood glucose caused by diabetes was observed by these above indexes .RESULTS:Water decoction of Platycladus orientalis lowered the increasing rate of weight , hepatic index and lipid content of liver , reduced the blood content of TC , TG and IL-6, and elevated the blood HDL-C and ADP content caused by high-fat diet apparently (P<0.05).The effect of water decoction of Platycladus orientalis at high dose was more effective than that at low dose .Water decoction of Platycladus orientalis obviously alleviated the abnormity of glucose tole-rance test, reduced blood TNF-αand insulin levels, and decreased insulin resistance index caused by diabetes apparently (P<0.05).The effect of the drug at high dose was stronger than that at low dose .CONCLUSION:The water decoction of Platycladus orientalis dose-dependently reduces blood glucose caused by diabetes and blood lipids caused by hyperlipi -demia in the mice.The mechanism to reduce blood lipids may be related with elevating blood ADP content and reducing blood IL-6 content, and the mechanism to reduce blood glucose may be related with lowering blood TNF-αcontent.

Objective To analyze the clinical features and prognosis of patients with infective endocarditis(IE) and acute kidney injury(AKI),and to evaluate the effect of timely operation on prognosis of renal function.MethodsClinical data of 45 IE and AKI cases in Peking Union Medical College Hospital from January 2010 to May 2016 were retrospectively reviewed;among them 8 cases underwent renal biopsy and the pathologies were analyzed.Patients were divided into Operation group(22 cases) and Non-operation group(23 cases),the clinical data and prognosis were compared.Results The ratio of male to female was 2.46:1 and the average age was 48.3±16.6.35.6% of cases were found with basic valve diseases,the congenital valve diseases were the most common type.The most frequently infected valves were mitral valve(46.7%),aortic valve(28.9%) and prosthetic valve(8.9%) ordinally.The most common pathogenic bacteria were streptococcus(46.7%) and staphylococcus(35.6%).Some rare and special pathogen could also be found in these cases.In 8 cases underwent renal biopsy,3 cases were diagnosed as crescentic nephritis,2 cases were diagnosed as focal proliferative glomerulone-phritis and mesangial prolif-erative glomerulonephritis respectively,1 case was diagnosed as acute interstitial nephritis.C3 sedimentation was the most common phenomenon found in immunofluorescence.There was no significant difference between the baseline data of Operation and Non-operation groups,and neither was the survival rate.However,renal function recovered better in Operation group(P<0.05): the serum creatinine declined remarkably in 7 days(P<0.05) and 30 days(P<0.01)post operation,compared with the peak valve before operation.Conclusions The underline valve diseases and pathogen have been changed in IE as compared with traditional description.Crescentic nephritis is common in renal pathologic manifestation when parenchymal lesion is developed after the onset of IE.Timely operation can improve the renal prognosis in patients with IE and AKI.

The present residents training for ultrasound departments depends mostly on poorlyscheduled rotation and clinical clerkship,with repeated and obsolete subjects in their training.The authors identified these setbacks and such characteristics as complication of ultrasound medicine,complex and variable ultrasonic scan technique,and the high threshold for beginners.In view of this,the authors adopted the tutorial system training mode for cultivating the residents in their medical care,teaching,research and foreign language competencies.A questionnaire survey of 44 residents so trained evaluated outcomes of the mode,with constructive suggestions raised on expansion of the training base,improvement of teachers’competency and reduction of trainees' workload.