Despite of great advances in drug management of heart failure in the past ten years,the condition remains a major public health issue,with high prevalence,poor clinical outcomes.Treatment of established systolic chronic heart failure includes agents that block the renin-angiotensin-aldosterone and sympathetic nervous systems to prevent adverse remodelling,to reduce symptoms and prolong survival.Diuretics,Vasodilator and Digoxin are often used to improve sign,with no influence on prognosis.Pharmacological agents aimed at new targets on clinically relevant endpoints are going under investigating.

Objective To explore the significance of blood lactic acid level and lactic acid clearance in evaluating the prognosis of septic shock.Methods The blood lactic acid concentration of 64 patients with septic shock EICU ICU admission 1h inside,6,12,24 and 48h was recorded,and the lactic acid clearance was calculated 12 hours after treatment,and according to lactic acid clearance of outcome,64 patients were divided into two groups,live group and death group;Then compared blood lactic acid level and lactic acid clearance between the two groups.Results The blood lactic acid concentration of live group and death group when enter the ICU was (7.2 ±5.4)mmol/L,(9.2 ±5.6)mmol/L respectivly,and was higher than normal,and of live group after 6h began to fall,and it reached normal level after 24h [ (2.2 ± 1.3 ) mmol/L ],but of death group after 48 h [ ( 8.0 ± 3.8 ) mmol/L ] was still significantly higher than normal,until death.There was significant difference between the two groups (t =3.7816,3.8257,7.5263,4.5875,5.8765,all P ＜ 0.05 ).The lactic acid clearance of death group after 12 hours was (5.83 ±3.92)mmol/L,and significantly lower than that of live group[ ( 14.32 ±2.68) mmol/L] (t =6.2565,P ＜0.05).Conclusion Blood lactic acid concentration was positively related to the prognosis of patients with septic shock,and dynamic response of disease progression by detecting lactic acid clearance rate could be early,sensitive,quantitative indicators to determine the severity of critical illness.

Objective To compare the clinical efficacy of laparoscope and open operation in treatment of adrenal pheochromocytoma.Methods 52 cases with adrenal pheochromocytoma were randomly divided into two groups,they were treated with laparoscope or open operation.Intraoperative blood loss,intraoperative blood pressure and heart rate fluctuations,operation time,drainage,hospitalization and postoperative complications were compared between two groups.Results Intraoperative comparison:In laparoscope group,operative blood loss was (65.7 ± 50.2) ml,blood pressure fluctuations in 1 case (3.8％),heart rate variability was (18.7 ± 6.1)/min and the operation time was (93.7 ± 21.7) min; in the open operation group,amount of bleeding during the operation was (240.4 ± 150.5) ml,blood pressure fluctuations in 7 cases(26.9％),heart rate variability was (25.6 ± 6.3)/min and the operation time was (137.7 ± 30.5) min,the differences between the two groups was significant (t =3.15,x2 =5.32,t =3.65,t =4.16,all P＜0.05).The maximum tumor diameter of open operation group was (7.3 ± 1.4) cm,which was bigger than that of the laparoscope group (6.6 ± 1.2) cm,but no significant difference between two groups (P ＞ 0.05).Postoperative comparison:in the laparoscope group,postoperative drainage was (174.3 ± 121.3)ml,drainage time was (4.3 ± 1.3) d and time of hospitalization was (8.4 ± 1.2) d,which were significantly less than those in open operation group(318.5 ± 132.6)ml,(8.7 ±2.3)d and (11.4 ±3.2)d(t =2.54 3.13,2.12,all P ＜0.05).No serious complications were observed in two groups,laparoscope group 1 case,open operation group 5 cases had postoperative pain,after the corresponding symptomatic treatment was improved.After 3 months of follow-up,clinical symptoms were significantly improved or disappeared,ultrasound or CT reexamination found no recurrence.Conclusion Laparoscope in treatment of adrenal pheochromocytoma not only has definite curative effect,but also has small trauma,shorter operation time and less complications,it is worth clinical application.

Objective To investigate the effect of low molecular weight heparin on lung Injury complicated by severe acute pancreatitis and explore its mechanism.Methods Ninety Wistar rats were randomly divided into 3 groups,namely sham operation (SO) group,acute necrotizing pancreatitis (ANP) group,low molecular weight heparin treatment (LH) group.4％ sodium taurocholate was injected into the pancreatic duct to induce ANP model.Subcutaneous low molecular weight heparin (10 U/100 g body weight) was injected in the LH group,the equivalent amount of normal saline was injected in the SO and ANP group.After 6,12,24 h,rats were sacrificed respectively,pancreas and lung tissues were harvested to observe the pathological changes and the pathological changes were scored;and the changes of TLR4 and VEGF protein expression in lung tissue was determined by immunohistochemical method.Serum and lung levels of IL-6,IL-l0,TNF-α were determined by ELASA method.Results The pancreas and lungs tissues were normal in SO group,diffuse hemorrhage,necrosis and a large number of inflammatory cells infiltration was observed in pancreas tissue in ANP group.Lung alveolar wall rupture,interstitial hyperemia,edema,a large number of infiltrating neutrophils could be seen in lung tissue in ANP group.The pancreas and lungs tissues injuries were significantly alleviated.The pancreas and lungs pathological scores of ANP group at 12 h were 6.34 ± 1.09,7.01 ± 1.16,and those were 5.48 ± 0.86,6.24 ± 0.86 in LH group,the values in LH group were significantly lower than those in ANP group (P ＜ 0.05),and there was a positive association between lung and pancreas scores (r =0.812,P ＜ 0.01).The expressions of TLR4,VEGF,IL-6,TNF-o,IL-10 in lung tissue of ANP group at 12 h were 0.68 ± 0.10,0.50 ± 0.11 and (2617.2 ± 485.3),(1603.1 ± 519.7),(608.3 ±137.5)pg/g,which were 0.61 ±0.09,0.41 ±0.06 and (2398.5 ±503.7),(1302.4±389.8),(753.2 ±100.0) pg/g in LH group,and the expressions of TLR4,VEGF,IL-6,TNF-α in LH group were significantly lower than those in ANP group,but the expression of IL-10 was significantly up-regulated,and the difference between the two groups was statistically significant (P ＜ 0.05).The serum levels of IL-6,TNF-α,IL-10 in ANP group at 12 h were (184.3 ± 45.7),(289.7 ± 60.4),(143.2 ± 30.4) μg/L,which were (143.8 ±31.8),(256.4 ±40.7),(189.3 ± 50.9)μg/L in LH group,and the levels of IL-6,TNF-α in LH group were significantly lower than those in ANP group,but the expression of IL 10 was significantly increased,and the difference was statistically significant (P ＜ 0.05).The expression of TLR4,VEGF in lung tissue was positively associated with the degree of lung injuries (r =0.524,0.503,P ＜ 0.05).Conclusions Low molecular weight heparin may improve lung injury complicated by ANP.The mechanism may involve inhibiting the expression of TLR4 and VEGF protein,IL-6,TNF-α,and up-regulation of the expression of IL-10.

Objective To assess the feasibility and the reliability of emergency temporary cardiac pacing under fluoroscopy and nofluoroscopy,and compare to the superiority and inferiority between two groups.Methods Fifty-seven patients were temporarily paced under fluoroscopy and nofluoroscopy by the way which the common bi-pole temporary endocardium pacing electrode was introduced into the right ventricle by the bi-subclavian vein and right internal jugular.Result Twenty-six patients were successfully paced under fluoroscopy,and 27 patients of 31 were successfully paced without fluoroscopy,the other 4 patients were not paced successfully.Besides,there was no any complication in all patients.Conclusion Emergency temporary cardiac pacing without fluoroscopy is utility,saving time and safety,Compared to other method,the effect is proximity and even superior than the way under fluoroscopy.The way of the emergency temporary cardiac pacing without fluoroscopy is applied widespreadly in the work of clinical first aid.

Firstly the paper expounds the fact that letting patients pick their doctors goes with the tide of social development: ①the connotation of medical quality determines the necessity of patients involvement; ②evaluation of medical quality has extended from self appraisal to social assessment; and ③the mechanism of letting patients pick their doctors conforms to the medical quality requirements of the times. Then the paper discusses the positive impact of letting patients pick their doctors on medical quality, including the choice of doctors by outpatients and the impossibility of doing so in medico technical and emergency departments or by inpatients. The paper also gives an account of the measures taken for safeguarding medical quality when adopting the practice of letting patients pick their doctors. Lastly the paper explains the boosting role of the practice and the difference between letting patients pick their doctors and letting them name particular surgeons for their operations.

After an account of the background to the practice of letting patients pick their doctors in the Third Central Hospital of Tianjin, the paper points out the positive impact of the practice, comments on the specific measures, and narrates the results that have been achieved. These include: ①enhanced awareness of self management on the part of the staff; ②increased cohesion of the hospital; ③higher efficiency; ④greater initiative on the part of the scientific and technical personnel as a result of the reform; ⑤social recognition of the reform; and ⑥a higher level of professional ethics building. Lastly the paper discusses the hospitals experience in adopting the practice of letting patients pick their doctors.

Objective To evaluate the short and middle-term outcome of metal surface hemiarthroplasty in treatment of femoral head osteonecrosis. Methods Forty-one patients (forty-eight hips) with average age of 40 years were performed hemi-arthroplasties and followed up for minimum 3 years. Thirty-five cases were at the stage of Ficat Ⅲand 13 at the stage Ⅳ and their acetabular were relatively normal. Measurements of the hip reconstruction were made on the anteroposterior pelvic radiograph assisted with computer. The outcome of metal surface hemi-arthroplasty and the correlation between the orientation of the femoral component and the migration of implant was evaluated. Results The mean duration of follow-up was 5.2 years. The average UCLA hip score was improved significantly (P

With the deeper development about the local medical service , the legionary hospital ought to strengthen the search on the economic circulation to ensure the advantageous station in the competition of medical market.By modulating the intersected situation of sanitation economy and finance, legionary hospital will adjust the source of sanitation economy and finance and build the new system to support the scientific decision-making about the economic circulation.