As the preferred treatment for most patients with hemodynamic instability in the intensive care unit (ICU),the fluid resuscitation can be limited by the cardiac function,that makes the fluid treatment has no responsiveness and may cause the risk of pulmonary edema increase.So,good fluid responsiveness is the basic condition to make fluid therapy successfully.For those patients,in order to lower the risk and correctly evaluate the fluid responsiveness,there are a large number of studies direct at the static and the dynamic pre-load parameters in animals and clinical patients.Those studies show that how to avoid the blindness of fluid expansion,accurately and effectively evaluate and forecast the fluid responsiveness.

Objective To calculate the social economic burden of mental illness,and to analyze the economic impact of different patients with mental illness in Shandong Province.Methods Direct method was used to calculate the direct economic burden,and human capital method was employed to estimate the indirect economic burden.Results The social economic burden increased from 10.076 billion in 2005 to 31.277 billion in 2013,and the proportion of the social economic burden accounting for GDP of Shandong province was between 0.5 ％ ～ 0.7％.The economic burden caused by women,18-39 years old patients,rural patients and mood disorders was higher than that of men,more than 55 years-old patients,urban patients and other diagnoses,respectively.Conclusions The economic burden brought by mental illness was heavy and increasing during 2005-2013.The economic burden caused by different people was heterogeneous.

Objective:To study the effect of endoscopic ligation for early stage carcinoma and benign polyp of stomach.Methods:The early stage cancer in situ and polyp (d＜1.0cm) of stomach were sucked and resected with the endoscopic ligation advice which is used in esophgeal varice ligation.The remained tissue were observed histopathologically whether there had any malignant cell in it and follow-up of 3～6 months was mode by endoscopy.Results:Form 1996 to 1999,56 patients received endscopic ligation.Of these patients,8 cases had gastric early carcinoma (2 cases superficial flat type,4 cases superficial elevated type,2 cases carcinoma in situ),48 cases had gastric benign polyps (38 cases infammatory polpy,10 cases polpypous adeoma).After the endscopic ligation,no malignnant cell was found in remained tissues and no polyp recured within the follow-up period.So this method was demonstrated to be safe,cheap and good effective method for early stage carcinoma,minicarcinoma,carcinoma in situ and benign polyp (d＜1.5cm) of stomach.It deserves being widespread.

Polyinosinic-polycytidylic acid is a synthetic analog of double-stranded RNA,which plays a vital role in the regulation of immune system.Toll-like receptor 3 ( TLR3 ),melanoma differentiation-associated gene 5 (MAD-5) and retinoic acid inducible gene - Ⅰ ( RIG- Ⅰ ) are the main three intracellular receptors binding to polyinosinic-polycytidylic acid which activates human anti-tumor immune responses including the activation of innate immunity and acquired immunity through TIR-domain-containing adapter-inducing inter feron-β (TRIF) and interferon-β.Thus,polyinosinic-polycytidylic acid plays an important role in regulating anti-tumor immune responses.The immunoregulation mechanisms ofpolyinosinic-polycytidylic acid in melanoma,breast cancer,malignant glioma and lung cancer have been clarified,which will provide new strategies for tumor immunotherapy.

Objective To investigate the effect of atorvastatin on endothelial diastolic function in patients with coronary artery disease.Methods he selected in January 2014 to December 2016 in our hospital make a diagnosis and give treatment of 80 patients with coronary heart disease(CHD)as the research object, the patients with its treatment is divided into two groups(control group and observation group)experiment, for the control group, 40 patients were treated with trimetazidine for observation group 40 cases of patients with trimetazidine+atorvastatin treatment;Compare the data of the two groups of patients.Results Observation group after treatment in patients with endothelial diastolic function level change is better than that of control group, the observation group vascular endothelin-1(60.48±12.72), nitric oxide(391.45±68.52), peripheral blood circulating endothelial microparticles(849.13±115.49), and other indicators are superior to control group vascular endothelin-1(70.47±15.52), nitric oxide(328.15±56.74), peripheral blood circulating endothelial microparticles(1019.67±127.52), compare the difference between groups was statistically significant(P< 0.05);The clinical therapeutic effect(95.0%)was superior to the control group(77.5%), and the difference in the group was statistically significant(P< 0.05).The incidence of adverse reactions(5.0%)was lower in the observed group(5.0%)than the control group(20.0%), and the difference in the group was statistically significant(P< 0.05).Conclusion Trimetazidine+atorvastatin therapy in patients with coronary heart disease in clinical effect is remarkable, can improve the endothelial diastolic function in patients with fully, is widely used in clinical treatment of coronary heart disease(CHD).

Objective To approach operative technique for chronic sub, dural hematoma (CSDH).Method The clinical information including general state of health, operative technique and prognosis of the 250 cases with CSDH were retrospectively analyzed. Results Within the 250 cases, 202 were old people with age over 50 and 176 had definite trauma history. In 25 cases treated by burr hole and drainage, 5 cases who had hematoma recurrence and 10 cases who had pneumocephalus, among whom, 6 had tensional pneumoeephalus, were all cured by second operation while the rest got cured. In 207 cases treated by burr hole, douche and drainage, no pneumocephalus or intracranial infection occurred. Twenty of them relapsed and were cured by second operation. Cerebral contusion eccurred in 1 case for pipe was inserted into the brain tissue by mistake, but it got better after active therapy. The other 18 cases were all cured through eraniotomy,hematomas removal as well as envelope excision. Conclusions CSDH is common in the old with age over 50 and it has relationship with head injury,mostly. The single hole trepanation, douche and drainage is simple, safe ,with minimal trauma and high cure rate. To master the operative technique including douching thoroughly, drainage through a pipe and brain protection is very important to the success of the operation.

Objective: To determine the long-term prognostic value of ~(99m)Tc-sestamibi (MIBI) Gated myocardial perfusion imaging(G-MPI)in patients with coronary artery disease.Methods: A total of 1345 consecutive symptomatic coronary artery disease patients who underwent ~(99m)Tc-MIBI G-MPI were studied.1250 patients were followed-up by telephone interview, the median follow-up time was 26.7±13.6 months.Events were defined as cardiac death, nonfatal myocardial infarction and revascularization by coronary artery bypass graft or percutaneous coronary artery intervention.Results: Cox regression analysis indicated that summed stress score (3.8±6.1,χ~2=67.25), summed different score (1.1±3.0,χ~2=21.09) and left ventricular ejection fraction (LVEF) (0.667±0.097,χ~2=42.26) were independent predictive factors of cardiac events (P<0.01).Kaplan-Meier analysis indicated that cardiac event free survival was significantly lower in the patient with LVEF≤50%.Conclusion: In Patients with symptomatic coronary artery disease, the summed stress score, summed rest score, summed different score and LVEF had prognostic value, and low LVEF indicated worse prognosis.

Objective To investigate the effect of atorvastatin on the expressions of solubility P-selectin(sP-selectin) and high sensitive C reactive protein(hs-CRP) in patients with percutaneous coronary intervention (PCI),and to explore the protective effect of atorvastatin on myocardium.Methods A total of 100 acute coronary syndrome patients having underwent successful PCI were enrolled in this study.All patients were divided into 3 groups by random digits table method:standard treatment group (group A,30 patients,atorvastatin 20 mg),low-dose atorvastatin pretreatment group (group B,35 patients,preoperative 12 h and 2 h atorvastatin 40 mg and 20 mg,respectively) and high-dose atorvastatin pretreatment group (group C,35 patients,preoperative 12 h and 2 h atorvastatin 80 mg and 40 mg,respectively).The level of sP-selectin was measured with ELISA.The level of hs-CRP was measured with latex enhanced immunoturbidimetry.Results Before operation,the levels of sP-selectin in group A,B,C were (2.32 ±0.40),(2.51 ± 0.33),(2.47 ± 0.28) μ g/L.After 6 and 12 h of operation,the levels of sP-selectin in group A,B,C were (4.12 ± 0.75),(3.34 ± 0.42),(3.31 ± 0.46) μ g/L and (5.64 ± 1.07),(4.08 ± 0.74),(3.84 ±0.48) μg/L.The levels of sP-selectin in group A,B,C after operation were significantly higher than that before operation (P ＜ 0.05).At the same time point,the levels of sP-selectin in group B,C after operation were significantly lower than that in group A (P＜ 0.05).Before operation,the levels of hs-CRP in group A,B,C were (4.32 ±0.51),(4.46 ±0.57),(4.29 ±0.43) mg/L,after 6 and 12 h of operation,the levels of hs-CRP in group A,B,C were (8.91 ± 1.34),(7.44 ± 1.06),(7.28 ±0.95) mg/L and (13.66 ± 1.49),(8.08 ± 1.14),(7.92 ± 1.04) mg/L.The levels of hs-CRP in group A,B,C after operation were significantly higher than that before operation (P＜ 0.05).At the same time point,the levels of hs-CRP in group B,C after operation were significantly lower than that in group A (P ＜ 0.05).The analysis of Pearson correlation showed,the level of sP-selectin was positively related with hs-CRP (r =0.753,P ＜0.01).The incidence of perioperative myocardial infarction was 23.3％ (7/30),5.7％ (2/35) and 2.9％ (1/35) in group A,B and C,respectively.The incidence in group A was significantly higher than that in group B and C (P ＜ 0.05).But there was no significant difference between group B and group C (P＞ 0.05).Conclusion The atorvastatin pretreatment can decrease the levels of sP-selectin and hs-CRP in patients after PCI,which play an important role in myocardium protection.

Objective To investigate the effects of remifentanil on lung ischemia-reperfusion (I/R) injury and expression of angiotensin-converting enzyme (ACE) mRNA in rats.Methods Forty pathogen-free adult male Sprague-Dawley rats,weighing 300-350 g,were randomly divided into 5 groups (n =8 each):sham operation group (group S),group I/R and different doses of remifentanil groups (groups R1-R3).Lung I/R was produced by occlusion of the left hilum of lung for 45 min followed by 120 min reperfusion.Remifentanil was infused intravenously at a rate of 0.2,0.6 and 1.2 μg·kg-1 ·min-1 until 120 min of reperfusion after a loading dose of 1 μg/kg at 15 min before occlusion of the left hilum of lung in groups R1,R2 and R3,respectively.The equal volume of normal saline was given in groups S and I/R.The rats were scarified at 120 min of reperfusion and lungs were removed for microscopic examination and determination of wet/dry lung weight ratio (W/D ratio) and the expression of ACE mRNA (by RT-PCR) in the lung tissue.The pathological changes of the lung were scored.Results Compared with group S,the pathological score and W/D ratio were significantly increased and the expression of ACE mRNA was up-regulated in groups I/R,R1 and R2,and the pathological score was significantly increased (P ＜ 0.05),and no significant change was found in W/D ratio and the expression of ACE mRNA in group R3 (P ＞ 0.05).Compared with group I/R,the pathological score and W/D ratio were significantly decreased and the expression of ACE mRNA was down-regulated in groups R2 and R3,and the pathological score and W/D ratio were significantly decreased (P ＜ 0.05) and no significant change was found in the expression of ACE mRNA in group R1 (P ＞0.05).Compared with group R1,the pathological score and W/D ratio were significantly decreased and the expression of ACE mRNA was down-regulated in group R3,and the pathological score and W/D ratio were significantly decreased (P ＜ 0.05) and no significant change was found in the expression of ACE mRNA in group R2 (P ＞ 0.05).The pathological score,W/D ratio and expression of ACE mRNA were significantly lower in groups R3 than in group R2 (P ＜ 0.05).The pathological changes of the lung were significantly reduced in groups R1-R3 as compared with group I/R.Conclusion Remifentanil can attenuate lung I/R injury in rats in a dose-dependent manner and down-regulation of ACE mRNA expression may be involved in the mechanism.