Objective To explore the effects of spironolactone on cardiovascular function in patients undergoing maintenance hemodialysis .Methods According to the random number table ,80 cases of patients undergoing maintenance hemodialysis in blood purification center of our hospital from December 2013 to June 2015 were randomly divided into the observation group and control group ,40 cases in each group .In the observation group ,patients were treated with spironolactone therapy ,while patients in the con‐trol group took a placebo .The cardiovascular function and related indexes were compared between the two groups .Results After 6 months of treatment ,the HR and BNP were decreased ,and CO ,SV ,SI and CI were increased in the observation group ,statistically significant differences were found in these indexes when compared with the control group (P<0 .05);there was no statistically sig‐nificant difference in HOI between the two groups(P>0 .05) .The PP ,MSP ,MDP ,MAP and ET‐1 in the observation group were significantly decreased after 6 months of treatment ,which were statistically different with those in the control group (P<0 .05) . Conclusion Spironolactone contributes to improving cardiovascular function of patients undergoing maintenance hemodialysis ,it is worthy of clinical application .

OBJECTIVE:To evaluate the economics of azithromycin vs. amocillin clavulante in the treatment of lower respirato-ry tract infections. METHODS:System evaluation was adopted to retrieve the randomized controlled trials(RCT)about azithromy-cin(test group)vs. amoxicillin clavulanate(control group)in the treatment of lower respiratory tract infections. Information was col-lected and Meta-analyses were performed. On this basis and short-term decision tree model,cost factors were added to conduct the pharmacoeconomics by the principle of PICO of Treeage Pro 2011 edition software. RESULTS:Totally 18 RCT were enrolled,in-volving 3 365 patients. Results of Meta-analysis showed that there were no significant differences in the effective rate [RR=0.93, 95%CI(0.55,1.55),P=0.77] and incidence of adverse reactions [RR=0.79,95%CI(0.62,1.0),P=0.05] between 2 groups. The av-erage treatment cost in test group and control group was respectively 790.4 yuan and 884.4 yuan,and cost-effectiveness ratio was respectively 216.0 and 245.7,and the incremental cost-effectiveness ratio(ICER)was -1 392.59. CONCLUSIONS:Azithromycin has similar efficacy and safety to amoxicillin clavulanate in the treatment of lower respiratory tract infection,however,azithromy-cin has better cost-effectiveness.

Objective To study the cardioprotection effects of heme oxygenase-1(HO-1)on cardiopulmonary resuscitation(CPR).Method Male Sprague-Dawley rats were asphyxiated for 9 minutes and resuscitated.Rats wefe randomly divided into 4 groups,namely,sham asphysiation group,CPR group,Hemin group and Heroin +ZnPP group(zinc protoporyphyrin IX).Resuscitated groups were further divided into two subgroups according to various intervals:6 hours and 24 hours after resuscitation.Hemodynamic was observed.Serum creatine phosphokinase-MB(CPK-MB)and lactate dehydrogenase were determined.HO-1 in heart tissue homogenates was assayed.Ultrastructure of rats hearts was examined.Statical evaluation was performed with analysis of variance.Results The mean blood pressure(MBP)in resuscitated groups was significantly reduced after resuscitation,hadn't any difference between supgroups.The scores of dp/dt 40 and-dp/dt were significantly decreased in CPR group and Hemin+ZnPP group after resuscitation(all P＜0.05),but dP/dt40 in Heroin group did nol differ significantly after resuscitation.and-dp/dt decreased only 0.5 hours and one hour after resuscitation and returned to baseline values two hours after resuscitation.The scores of dp/dt 40and-dp/dt in Heroin group at different intervals after resuscitation were significantly higher than those in CPR group and Hemin+ZnPP group(all P＜0.05).Serum CPK-MB and LDH in CPR group and Hemin+ZnPP group at 6 hours and 24 hours after resuscitation were significantly higher than those in Hemin group(all P＜0.05).The cardiac tissue ultrastructure of rats in Hemin group was more intact than that of CPB group and Hemin+ZnPP goup.HO-1 levels in heart tissue homogenates of Hemin group at 6 hours and 24 hours after resuscitation were significantly higher than those in CPR group and Heroin+ZnPP group(all P＜0.05).Conclusions HO-1 expression induced by Heroin can effectively improve post-resuscitation myocardial dysfunction,alleviate cardiac injury,keep the ultrassructure integrity of cardiac myocytes.It may be a new approach to treat myocardial dysfunction after resuscitation.

BACKGROUND:A cross-emulsification patented product of microporous polysaccharide hemostatic powder was prepared using potatoes as raw material with independent intel ectual property rights.
OBJECTIVE:To observe hemostasis effects of microporous polysaccharide hemostatic powder on soft tissue trauma.
METHODS:A wound, about 3 cm long and 0.5 cm deep, was made on the abdominal soft tissue of rabbits in the experimental group 1, and then microporous polysaccharide hemostatic powder, 1.0-2.0 g, was sprayed directly on the wound. In the experimental group 2, a wound, about 3.0 cm long and 1.0 cm deep, was made on the abdominal soft tissue of rabbits, and then microporous polysaccharide hemostatic powder, 1.0-2.0 g, was sprayed directly on the wound. Another rabbits with untreated wound served as controls.
RESULTS AND CONCLUSION:Microporous polysaccharide hemostatic powder formed a“pasty gel”covering the bleeding wound that achieved hemostatic effect. The bleeding time was (15.25±1.04) seconds in the experimental group 1 and (11.25±1.89) seconds in the experimental group 2. The marked effective and effective rates for hemostasis were 87.5%and 100%, respectively. In the control group, the bleeding time was more than 5 minutes. Hematoxylin-eosin staining showed mild muscle edema, vasodilatation of smal blood vessels, and few scattered endoplasmic neutrophils infiltrated at 24 hours after treatment with microporous polysaccharide hemostatic powder;til the 7th day, inflammation subsided, mild fibrosis was visible on muscle tissue surface, the hemostatic powder was completely absorbed, the wound tissue was close to the normal tissue, and there were no significant changes in muscle cells. These findings suggest that microporous polysaccharide hemostatic powder can be used for hemostasis of soft tissue trauma.

Objective Observation of 2 diabetic patients with insulin homocysteine(Hcy) levels before and after treatment ,to explore new diagnosis of diabetes patients with blood glucose control for the effect Hcy .Methods Extracted from 128 cases accord with standard of newly diagnosed type 2 diabetic patients ,randomly divided into control group and strengthen group ,64 cases each . Give control group oral sulfonylureas .To observe group use insulin intensive therapy .In the three months after treatment compared two groups before and after treatment of FBG ,HbA1c indicators related to change .Results All patients after treatment ,Hcy , FBG ,PBG ,HbA1c have decreased ,and Hcy in strengthen group decreased more obviously than in control group ,the difference was statistically significant level changes(P<0 .05) .Conclusion Insulin intensive therapy can be effective in the treatment of newly di‐agnosed type 2 diabetes .

BACKGROUND:The growth of mesenchymal stem cells in vitro in different conditioned media is different evidently. So it is necessary to choose a more suitable medium. OBJECTIVE:To contrast and observe the proliferation of human umbilical cord mesenchymal stem cells in three kinds of media and to check the immunophenotype and differentiation ability of mesenchymal stem cells. METHODS:Human umbilical cord mesenchymal stem cells were col ected by explant method in sterile conditions. After subculturing by T75 incubation bottles, the third generation of mesenchymal stem cells were cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 medium containing 5%fetal bovine serum, Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum and Mesen PRO RSTM medium. After 1, 3, 5, 7 days of culture, the cells were counted to draw a growth curve. Immunophenotype of the third generation of umbilical cord mesenchymal stem cells were determined by flow cytometry and the ability of osteogenic and adipogenic differentiation was also detected. RESULTS AND CONCLUSION:The third generation of cells cultured highly expressed CD44, CD73, CD90, CD105, but did not express CD29, CD31, CD34, HLA-DR. The oil red O staining showed a lot of little red lipid drops after adipogenic induction;alizarin red staining showed osteoblast-like cells after osteogenic induction, indicating umbilical cord mesenchymal stem cells in vitro have the potential of multi-directional differentiation. After observation and counting, the colony and shape of cells cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum were superior to those cultured in the other two media. Therefore, it is concluded that Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum is preferred for cellsubculture.

Objective Analyze the causes of ambiguous medical records to provide evidence for the DRGs.Methods 268 Ambiguous medical records were selected from 17 751 surgery medical records between 2010 and 2014 based on major diagnosis and major surgery.The single factor Chi-square test was used to study the influence of various inpatient characteristics on the occurrence of ambiguous medical records, and those significant variables were given assignment to find influencing factors of ambiguous medical records by using logistic regression analysis.Results Ambiguous medical records account for 1.51％ of all surgical medical records.Logistic regression analysis results show that such risk factors as discharging from internal medicine, death of patient, transfer between departments, elderly, long time of hospitalization, and tumor patients, as contributing to ambiguous medical records.All the results are statistically significant (P＜0.05), including discharging from which departments (OR=6.595, 95％CI..5.043 ～ 8.625), death of patient (OR=3.787, 95％ CI: 2.611 ～ 5.492) and transfer between departments (OR =2.746, 95％ CI: 2.061 ～ 3.659), which rank important risk factors for ambiguous medical records.Conclusion Analysis of the causes of ambiguous medical records provides important evidences for the hospital to improve its medical record quality management.

BACKGROUND:Microporous vacuum polysaccharide hemostatic microspheres are derived from degenerated potato plant starch and prepared through special processing. It is an ideal absorbable polymer styptic material with independent intelectual property rights. OBJECTIVE: To observe the degradation of microporous vacuum polysaccharide hemostatic microspheres and detect the safety indicators of body fluids by implanting microporous vacuum polysaccharide hemostatic microspheres in rats. METHODS:0.1-0.2 g microporous vacuum polysaccharide hemostatic microspheres were implanted subcutaneously on the left side of the spine in 12 rats. At the 1st, 3rd, 7th and 14th days after implantation,the degradation of microporous vacuum polysaccharide hemostatic microspheres in the tissue was observed. Another 15 rats were selected, of which 5 rats were taken as the control group and fed normally, and 10 rats were subjected to anesthesia. Two incisions were made on both sides of the spine, about 5 cm, deep into the muscular layer of 0.3 cm. The right amount of hemostatic microspheres were sprayed on the incisions and covered the entire wound, then the incisions were sutured. The 10 rats were raised normally for 14 days. The various indicators of body fluids such as appearance features, activities, excretion, feeding were detected. Finally, the rats were dissected, and the gross morphology and color changes of main organs were observed. RESULTS AND CONCLUSIONS: The microporous vacuum polysaccharide hemostatic microspheres buried in rats were completely degraded and absorbed within 7 days. After spraying the right amount of microporous vacuum polysaccharide hemostatic microspheres on the incision, the vital signs and biochemical indicators, such as blood and urine tests were all normal. The gross morphology and color of main organs such as liver, spleen, brain and kidney were not found significant anomalies. These results demonstrate that microporous vacuum polysaccharide hemostatic microspheres can be degraded into monosaccharide by amylase and can be completely degraded and absorbed within 7 days, without any side effects to tissues and organs.

Objective : To investigate the AIDS-related knowledge and behaviors and health service demand among secondary vocational school students in Shanghai Municipality, so as to provide the evidence for formulating the HIV/AIDS health education and behavioral interventions among secondary vocational school students. Methods : Three secondary vocational schools were randomly sampled in Shanghai Municipality using a stratified cluster sampling method from September to November in 2019, and grade was stratified in each school. Then, a class was sampled from each grade, and all students in this class were sampled. Participants' demographics, AIDS-related knowledge, sexual behaviors, and health service needs for AIDS control were collected using questionnaires and descriptively analyzed. Results : Totally 2 078 questionnaires were allocated, and 2 022 questionnaires were recovered, including 2 013 valid questionnaires (99.55%). The respondents had a median age of 16 years (interquartile range, 2 years), and included 1 366 men (67.86%). A low awareness rate was found for “Self-testing may understand HIV/AIDS infection status” (40.83%) and “Mosquito bites fail to transmit HIV” (37.95%). There were 182 respondents with sexual behaviors (9.04%), including 47 respondents with use of condoms during each sexual behaviors (25.82%), 20 respondents with multiple sexual partner behaviors simultaneously (10.99%), and 21 respondents that had received HIV testing (11.54%). There were 807 respondents with questions about sex and reproductive health (40.09%), and 852 respondents that wished to acquire answers from professional network platforms and professionals (42.32%). Conclusions The awareness of HIV/AIDS transmission route and use of condoms is low among secondary vocational students in Shanghai Municipality, and there are high-risk behaviors for HIV/AIDS among students. The secondary vocational school students are most eager to obtain the answers from professional institutions and professionals if there are questions about sex and reproductive health.

Objective To investigate the expression level of immunoglobulin G (IgG)4 cells in patients previously diagnosed as unexplained liver injuries,and to analyze whether these patients could be diagnosed as immunoglobulin G4-related disease (IgG4-RD).The clinical characteristics of patients with IgG4 positive cells infiltration in liver tissues who did not met IgG4-RD diagnosis criteria were also analyzed.Methods From August 2010 to July 2016,33 patients with unexplained liver injuries even after liver biopsy were enrolled.Immunostaining of IgG and IgG4 in liver tissue slices was performed.Whether the patients met the IgG4-RD diagnosis criteria was analyzed.Also,the relation between IgG4 positive cell infiltration in liver tissues and serum parameters (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyl transpeptadase (GGT),IgG),the classification of liver inflammation and stage of liver fibrosis were analyzed.Chi-square,Fisher exact probability method,t test and Wilcoxon rank and inspection were used for statistical analysis.Results Among 33 patients with unexplained liver injuries,average age of onset of the disease was (50.48 ± 14.52) years old.Ten patients (30.3 ％) presented with different degree of IgG4 positive cells infiltration in liver.In one patient,the IgG4 positive cell number in liver tissue was over 10/high-powered field (HPF),IgG4+ / IgG+ ratio was over 40％,the serum IgG4 increased and low density nodules in the left hepatic lobe level,which met the diagnostic criteria of IgG4-RD.Serum parameters of liver function of this patient were as follows:ALT 948 U/L,AST 658 U/L,ALP 176 U/L,GGT 197 U/L,TBil 21.5 μmol/L,DBil 10.0 μmol/L.According to whether there were IgG4 positive cells infiltration in liver tissues,33 patients were divided into IgG4 positive cells infiltration group (IgG4 positive group,10 cases) and no IgG4 positive cells infiltration group (IgG4 negative group,23 cases).The medium levels of ALT,AST,ALP and GGT in the IgG4 positive group and the IgG4 negative group were 26.0 U/L vs 31.0 U/L,28.5 U/L vs 32.0 U/L,114.0 U/L vs 77.0 U/L,65.0 U/L vs 36.0 U/L,respectively and there were no statistically significant differences (Z=-0.098,-0.216,-0.862,-0.705;all P＞0.05).The serum IgG level of the IgG4 positive group was higher than that of the IgG4 negative group (17.15 g/L vs 13.65 g/L),and the difference was statistically significant (Z=-1.776,P =0.035).Conclusions IgG4-RD may be the reason of liver injury.There are no significant differences in clinical charateristics,serum parameters and inflammation degree in liver tissue between patients with or without IgG4 positive cells infiltration.