Objective To explore the perioperative antithrombotic strategy in percutaneous coronary intervention(PCI)for the patients with coronary heart disease(CHD)who were treated with long-term warfarin anticoagulation,and to evaluate the safety of the strategy and short-term efficacy.Methods The clinical data of 76 patients were analyzed,who underwent coronary stenting while treated with long-term warfarin anticoagulation.All of them had unstable angina.The reasons of requiring warfarin anticoagulation were cardiac valve replacement [51(67.1%)],pulmonary embolism within half a year [6(7.9%)],and sustained atrial fibrillation at high risk of stroke [19(25.0%)].Warfarin was withdrawn and low molecular weight heparin(LMWH)was administered as alternative anti-thrombus drugs before PCI.PCI was performed when international normalized ratio(INR)went less than or equal to 1.3.LMWH was administered combined with low dose aspirin(100mg/d)and clopidogrel(75mg/d)post PCI,while warfarin was resumed too.When INR arrived at 1.8,LMWH was withdrawn.Warfarin was administered in a dose adjusted to achieve the target INR of 1.8 to 2.3.Clopidogrel was withdrawn 1 month later.Aspirin(75-100mg/d)was continued,and then warfarin was resumed to the dose before PCI.The data of the incidence of ischemic events,major adverse cardiac events(MACE),subacute instent thrombus(SAT),and hemorrhage events during hospital period were analyzed.Results The incidence of hemorrhage events was 5.3%(4/76),one of them was secondary hemorrhage events.The rate of MACE was 1.3%(1/76).No main hemorrhage events and SAT occurred during hospitalization related to regulating antithrombotic strategy.Conclusions As alternatives of warfarin,LMWH is taken before PCI,and then the low dose of aspirin,clopidogrel,LMWH and warfarin are admitted in a short period after PCI,the dosage of warfarin should be accurately adjusted according INR post PCI,and then the LMWH is taken out of service timely,such a strategy is safe and efficient in peri-percutaneous coronary intervention for the patients with CHD who were treated with maintaining warfarin anticoagulation.

Objective The purpose of our research was to quantitative study the degeneration of lumbar intervertebral discs by using T2 mapping technology at 3.0T MR and research the correlation of biomechanics and lumbar disc degeneration.Methods 34 patients with low back pain or sciatica were enrolled.The correlation of T2 values of lumbar intervertebral discs and Pfirrmann grading,disc location,patient ages were analyzed.T2 values before and after loading were also analyzed.Results T2 values of nucleus pulposus were correlation with Pfirrmann scoring,disc location and,patient ages.Conclusion (1 )T2 mapping provides a non-invasive and quantitative way to diagnose lumbar discs degeneration.(2)The change of external pressure load can affect the T2 values of the intervertebral disc.

Objective The aim of the study was to analyze the predictive value of the European system for cardiac operative risk evaluation score (EuroSCORE) and the Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) in -dult patients undergoing aortic valve replacement (AVR).Methods We carried out a retrospective statistical analysis on 521 adult patients undergoing AVR between 1999 and 2008 in Changhai hospital.Patients with concomitant coronary artery bypass grafting were also included.Excluded from this study were patients having surgery for congenital heart defects,aneurysm of thoracic aorta and atrial fibrillation.Operative mortality was defined as death before discharge from the hospital.The mortality risk calculation of EuroSCORE and STS-PROM for aortic valve procedures was performed by the online available EuroSCORE or STS score calculator.Based on the additive EuroSCORE risk calculation,patients were divided into low-risk,medium-risk and high-risk groups.The valuation of three different algorithms depended on the assessment of two features:calibration and discrimination.A comparison of observed and predicted mortality rates was also performed.Results A total of 521 patients were identified as having undergone aortic valve replacement.In-hospital mortality was 4％ (21 cases) overall.The expected mortality for the additive,logistic EuroSCORE and the STS-PROM was 3.36％,2.82％ and 1.25％,respectively.The observed to expected ratio was 1.2 for additive EuroSCORE,1.43 for logistic EuroSCORE and 3.23 for STS-PROM.The STS-PROM underpredicted observed mortality significantly ( P ＜ 0.01 ) and showed poor calibration in predicting in-hospital mortality in the entire cohort,medium- and high-risk subgroups.The logistic EuroSCORE underpredicted observed mortality in the mediumrisk subgroup ( P ＜ 0.05 ).EuroSCORE underpredicted in-hospital mortality in the high-risk subgroup with the observed-expected mortality rate of 1.84 for additive EuroSCORE and 1.46 for logistic EuroSCORE.The EuroSCORE in three subgroups showed poor discrimination in predicting mortality as well as the STS-PROM did in the medium- and high-risk subgroups ( ROC ＜ 0.7).Conclusion Both the EuroSCORE and the STS-PROM give an imprecise prediction for individual operative risk in patients undergoing aortic valve replacement in our study.These algorithms seem unsuitable to identify a high-risk patient population undergoing isolated AVR.It is necessary to construct a risk stratification model for valve surgery according to the profiles of Chinese patients.

Objective To discuss the features,such as clinical symptoms,pathologic morphologies,immunohistochemical staining of minimal deviation adenocarcinoma and microglandular hyperplasia of the uterine cervix in order to improve the accuracy of pathological diagnosis.Methods s:Histopathologic characteristics of total hysterectomies in 2 cases of minimal deviation adenocarcinoma and 1 case of cervical microglandular hyperplasia based on the formalin-fixed,paralfin-embedded and hematoxylin-eosin stained tissue were analyzed retrospectively.Immunohistochemical staining was used to detect the expression of CEA,p53,PCNA,and Ki-67 in all 3 cases.Results The main clinical symptoms of minimal deviation adenocarcinoma were watery leucorrhea and enlargement of the cervix.The pathological findings of MDA included hyperplasia of the glands with cytological minimal atypia,invasion effects into the stroma could be observed in some glands and abortive glands with desmoplastic changes,or edema and inflammatory infiltration around the glands were also observed.The invasion presented in the deep part of the cervix as well.The patiant of MGH had a history of oval contraceptive use.Histological features of MGH included tightly packed glands in different sizes and shapes,presentation of inflammatory cells in stroma and glandular lumens,and focal epithelial cell pleomorphism and hyperchromatism but without mitosis.CEA was positive in all two MDA cases,but the tissue of MGH was negative for CEA.The expressions of the other four markers had no difference between MDA and MGH.Conclusions For patients with watery discharge and/or hypertrophy of cervix,the deep ( ＞ 5 mm ) biopsies should be performed.The immunohistochemical staining for CEA,p53,CA125 and ER has adjuvant diagnostic values.It is extremely important to recognize that MGH is an entirely benign lesion.

This paper introduces the implementing schemes of cochlear implants, signal processing strategies and current state-of-the-art implant processors. The paper mainly discusses the key questions which would come up in designing cochlear implant system. Eventually we express our opinions about the development and further research of cochlear implants.
Algorithms ; Cochlear Implants ; Deafness ; rehabilitation ; Humans ; Prosthesis Design ; Signal Processing, Computer-Assisted

Rapid eye movement sleep behavior disorder (RBD) is a condition characterized by rap id eye movement sleep without atonia and with complex behaviors associated with dreams.Numerous studies have revealed that idiopathic RBD is the prodromal manifestation of neurodegenerative disorders,especially those mediated by α-synuclein.The structural and functional imaging of RBD,including transcranial sonog raphy (TCS),MRI,SPECT,PET,are increasingly becoming the hot issues.This review summarizes the radionuclide imaging in RBD,which may be one of the most promising modalities to detect the biomarkers for early diagnosis of neurodegenerative disorders.

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BACKGROUND: The role of excision repair cross-complementation group 1 (ERCC1) has been controversial in non-small cell lung cancer (NSCLC) patients who received adjuvant chemotherapy with a platinum agent. We investigated ERCC1 expression in stage I-II NSCLC to clarify its significance for adjuvant chemotherapy. METHODS: The ERCC1 expression profile was evaluated by immunohistochemistry and compared according to adjuvant chemotherapeutic agents in 146 patients who underwent surgical resection for stage I-II NSCLC. The patients were divided into 3 groups; adjuvant chemotherapy with a platinum based agent (18.5%, 27/146); adjuvant chemotherapy with uracil-tegafur (UFT) (40.4%, 59/146); surgery-alone (41.1%, 60/146). RESULTS: Nuclear ERCC1 expression was detected in 71.9% (105/146) of NSCLC and was significantly associated with a shortened survival period in the group 1 patients who received the platinum based regimen after surgery. The group 2 patients who received UFT showed the longest survival period, followed by the surgery-alone group (overall survival, p=0.049; disease-free survival [DFS], p<0.001). CONCLUSIONS: These results suggest that stage I-II NSCLC patients with ERCC1 expression experience a shorter DFS period with adjuvant chemotherapy with a platinum based regimen and may benefit from adjuvant chemotherapy with UFT, instead of platinum after surgery.
Carcinoma, Non-Small-Cell Lung ; Chemotherapy, Adjuvant ; Disease-Free Survival ; DNA Repair ; DNA-Binding Proteins ; Endonucleases ; Humans ; Immunohistochemistry ; Platinum

Objective To summarize the characteristics of deltoid ligament rupture and explore the feasibility and shortterm clinical outcomes of targeted suture anchor repair technique according to the rupture site.Methods From May 2011 to October 2014,19 cases of complete deltoid ligament rupture (17 males and 2 females) were recruited in this study,with an average age of 34.15± 1.23 years (ranged from 15 to 60 years).According to Lauge-Hansen classification,there were 7 cases of pronation external rotation grade ⅣV injury,including 3 cases of Maisonnuve fracture;1 case of pronation abduction type Ⅲ degree injury,1 case of pronation abduction grade ⅣV injury;and 10 cases of supination external rotation grade ⅣV injury.According to AO / OTA classification,there were 9 cases of 43B type injury and 10 cases of 43C type injury.According to the rupture site of deltoid ligament,the targeted suture anchor repair surgery was operated respectively.Early mobilization with the help of hinged ankle brace was encouraged.The evaluation at last follow-up was based on the American Orthopedic and Ankle Association (AOFAS) criteria of ankle and hindfoot,and the visual analogue scale (VAS) scoring system.Results Nineteen patients were all followed up for 24 to 48 months,with an average of 30.42±5.11 months.Fourteen cases (73.7％,14/19) with talus end avulsion were treated by double suture anchor in the talus,with continuous locking suture of the avulsed end.Four cases (21.1％,4/19) with middle part rupture were treated by double suture anchor in the talus,with the sutures crossing three bone tunnels at the medial malleolus.One case (5.3％,1/19) with medial malleolus end avulsion was treated by single suture anchor at the medial malleolus,with continuous locking suture of the avulsed end.At the last follow-up,the AOFAS score was ranged from 70 points to 96 points,with an average of 90.53 points,and excellent in 16 cases,good in 2 cases,fair in 1 case,excellent and good rate was 94.7％.The VAS score was ranged from 0 to 2 points,with an average of 0.42 point.No wide medical clear space was detected.But traumatic arthritis was happened in 2 patients.Conclusion The targeted suture anchor repair technique according to the rupture site was a save technique in treating deltoid ligament rupture,which is conducive to early postoperative functional exercise,with excellent short-term clinical outcomes and few complications.

OBJECTIVE： To provide reference for improving emergency capacity of the hospital pharmacy department in response to the novel coronavirus pneumonia （COVID-19） epidemic. METHODS ：According to the related regulations and requirements of Law of the People ’s Republic of China on the Prevention and Control of Infectious Diseases ，combined with the situation of COVID- 19 epidemic prevention and control ，and management experience of relevant hospitals ，on the basis of in-depth analysis of drug supply and quality assurance ，drug dispensing management ，provision of clinical pharmaceutical services and other related material support of hospital pharmacy department，integrated emergency management model was constructed for COVID- 19 epidemic prevention and control ，and the precautions and response measures of each link were sorted out. RESULTS ：Integruted emergency management mode for COVID-19 epidemic prevention and control in hospital pharmacy department included but was not limited to human resource management，drug and disinfection products supply management （mainly including key treatment drugs and disinfection product list formulation，control，inventory increase ，etc.）；drug dispensing management （mainly including prescription ，pharmacy window ， planning quantitative reserve ， drug return ， etc.）；clinical pharmaceutical care management （mainly including providing pharmaceutical information support ，online pharmaceutical service ，monitoring drug safety ，etc.）；personnel protection and disinfection （mainly including personnel protection ，environment and window ，equipment and container ，paper prescription disinfection，etc.）；special management of donated drugs ；prevention and control knowledge training ；pharmaceutical education and scientific research management ，etc. CONCLUSIONS ：The integrated emergency management model for epidemic prevention and control is helpful for hospital pharmacy to manage public health emergencies. During the outbreak of COVID- 19，hospital pharmacy department should start integrated emergency management mode for epidemic prevention and control ，strengthen the risk control of each link ，and play a good role in the key functional departments in the special period.