Objective To study the utility of inferior vena cava-collapse index (IVC-CI) for assessing fluid resuscitation for hypovolemic shock in order to look for better echocardiographic markers to assess patients' condition with hypovolemic shock,also to look for optimal guidance for the adjustment of the treatment for these patients.Methods A total of 40 patients with hypovolemic shock admitted to Emergency Department were enrolled for study.All patients were treated with 500 mL normal saline iutravenously as fluid resuscitation.The vital signs and echocardiographic findings before and after the treatment were documented.Comparison of data between pre-treatment and post-treatment was carried out.Results Of 40 patients,there were 23 male and 17 female with average age (50.00 ± 17.71) years.The time consumed for echocardiography examination was (8.68 ± 5.73) min,time required for establishing central line was (29.32 ± 8.06) min.Collapse index of inferior vena cava (IVC-CI) before and after treatment were (0.43 ± 0.16) and (0.38 ± 0.13),respectively.In hypovolemic shock group,the relationship of the peak velocity (Vpeak) of left ventricular outflow between before and after treatment was r =0.75,P =0.001.The relationship of the peak velocity of left ventricular outflow with left ventricular end diastolic volume (LEDV) before treatment was P =0.03 and after treatment was P =0.05.Conclusions (1) Between IVC-CI and the effectiveness of fluid resuscitation,there was no relationship.It was inappropriate to take IVC-CI as a marker for assessment.(2) Vpeak increased apparently after the fluid resuscitation.(3) Vpeak was proved to be associated with LEDV which supported that Vpeak is the indicator of left ventricular contractility.(4) Time consumed for echocardiography examination was shorter than that for establishing the central line in the group.

Objective To study the prevalence and risk factors of chronic kidney disease (CKD) among adults in Zhengzhou. Methods One thousand eight hundred and fifty five residents (≥ 20 years) from 4 communities in 4 districts of Zhengzhou city were randomly selected by using a stratified,multistage sampling. They were interviewed, and received physical examination and measurements of urine and blood for renal damage as well as risk factors. Results Eligible data of 1752 subjects were included in the study. After the adjustment of age and gender component, albuminuria was found in 5.78% of the subjects, hematuria in 8.19%, and reduced renal function in 1.58%. Male had lower prevalence of albuminuria and hematuria (4.37% vs 7.29%, X2=6.252, P=0.012; 5.08% vs 11.51%, X2=24.499, P＜0.01), but higher prevalence of reduced eGFR(2.26% vs 0.86%, X2=5.830, P=0.016) as compared with female. The prevalence of albuminuria and reduced eGFR increased with age. The crude prevalence of CKD was 14.50%, while the standardized rate was 13.57%. The prevalence of female was higher than that of male (17.83% vs 9.59%, X2=23.132, P＜0.O1), which also increased with age. The most common manifestations of CKD were hematuria and albuminuria. Gender, age, smoking, hypertension,diabetes mellitus, obesity and hyperuricaemia were independently associated with CKD. The awareness rate of CKD was 8.27% and only 7.09% of the subjects received treatment. Conclusions The prevalence of CKD is 13.57% and the recognition is 8.27% in urban adult population of Zhengzhou.lndependent risk factors associated with kidney damage are gender, age, smoking, hypertension, diabetes mellitus, obesity and hyperuricaemia.

Objective To explore the prevalence of chronic kidney disease(CKD) and its related risk factors in the people aged 60 years or over in Zhengzhou.Methods One thousand two hundred and ninety-one residents aged 60 years or over were selected with stratified-multi-steps-cluster sampling method in 4 communities from 4 different districts in Zhengzhou city.The indicators of renal damage and its related factors were collected with questionnaires.Results Eligible data of 1247 subjects were collected.After adjustment for age and gender, the prevalence of albuminuria,hematuria and reduced eGFR were 13.3% ,6.0% and 2.0% respectively, and the prevalence of CKD was 17.5%.Multiple logistic regression analysis showed that hypertension, diabetes and overweight were independent risk factors for CKD.Conclusions The prevalence of chronic kidney disease in the urban people aged 60 years or over in Zhengzhou is higher than in the non-elderly people and preventive measures should be adopted.

Teaching reform for medical statistics in postgraduate students was undertaken in order to comply with the longitudinal thought of medical research and to cultivate student's abilities of solving actual problems. The contents of theory courses and practicum courses were re-enacted and some advanced statistical methods commonly used in medical research were added. Meanwhile,the contents of practicum courses were reformed following the guideline of ‘application of statistics in the research’ and the teaching method of task-driven teaching combined with problem-based learning was used in the process. Furthermore, evaluation on the teaching effect was made. The reformed teaching model greatly excited student's learning enthusiasm and developed their abilities of applying statistics in scientific research.

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.

To evaluate the clinical effects of Shengmai Injection in treating coronary heart disease (CHD) based on correct syndrome differentiation and incorrect syndrome differentiation.

To analyze the relationships among syndrome, therapeutic method and Chinese herbal medicine in patients with coronary artery disease (CAD).

Objective To study the clinical efficacy and safety of double incision double plate internal fixation in the treatment of complex fractures of tibial plateau .Methods According to the different treatment methods , 83 patients with tibial plateau complex fractures were divided into double plate group ( 51 cases ) and locking plate group ( 32 cases ) .The surgical indicators , treatment efficacy and complications were compared between the two groups .Results The time of implantation ,hospital stay and fracture healing time in the observation group were signif-icantly shorter than those in the control group [(9.36 ±2.14) d vs.(13.24 ±2.99) d;(11.71 ±1.32) d vs. (13.41 ±2.23)d;(13.27 ±1.83)weeks vs.(15.82 ±2.18)weeks],the differences were statistically significant (t=6.813,4.368,5.736,all P<0.05).The excellent rates of HSS score in the observation group and the control group were 94.12％and 93.75％,respectively,and there was no statistically significant difference (χ2 =0.746,P>0.05).The incidence rate of complications in the observation group was significantly lower than that in the control group(5.88％vs.21.88％) (χ2 =4.746,P<0.05).Conclusion Double-incision plate internal fixation surgery for tibial plateau complex fractures is effective ,has fast postoperative recovery ,high safety,and it is worthy of clinical application in a wide range of popularization .

Objective: To understand the status quo of social support for and social adaptation of HIV/AIDS patients in Henan province, analyze the relationship between social support and social adaptation, and provide reference for improving the quality of life of HIV/AIDS patients. Methods: A multi-stage stratified random sampling method was adopted to select HIV/AIDS patients in high HIV prevalence areas (Shangcai, Shenqiu), middle epidemic areas (Queshan, Yongcheng), low prevalence areas (Jiyuan, Sanmenxia) in Henan province. A social support scale was used to investigate the three dimensions of objective support, subjective support and support utilization. A social adaptation scale was used to investigate the three dimensions of patient cognitive willingness, social interaction and role adaptation. Finally, the characteristics of the social support, social adaptation and their relationships were analyzed. Results: The overall score of 506 HIV/AIDS patients’ social support was 36.30±9.34, the score of objective support was 7.48±3.01, the score of subjective support was 22.35±5.79, and the score of support utilization was 6.28±2.38, the overall score and the scores of three dimensions of social support of HIV/AIDS patients were lower than the national levels, and the differences were statistically significant (P<0.05). The overall score of patients’ social adaptation was39.10±7.10, the score of cognitive willingness was 9.96±3.23, the score of social interaction was 18.57±3.25, and the score of role adaptation was 10.57±2.52. The average score of social adaptation of patients was less than 2/3 of the overall score, and the average cognitive willingness score was less than 1/2 of the overall score. The differences in social support score and social adaptation score among patients with different gender, age, marital status, occupation, transmission route, number of symptoms were statistically significant (P<0.05). For the HIV/AIDS patients, there was a correlation between the social support and the social adaptation (r=0.14, P<0.05). Conclusion HIV/AIDS patients had a low level of social support and social adaptation, and social support might be a contributing factor to the social adaptation of HIV/AIDS patients.

OBJECTIVETo evaluate the effect of endoscopic surgery for maxillary sinus inverted papilloma.

METHODSFrom 2000 to 2011, 50 patients with maxillary sinus inverted papilloma were treated with intranasal endoscopic surgery or combined approach. Among them, 39 cases were primary and 11 cases were recurrent, which included 17 patients with Krouse stage IIand 33 cases with Krouse stage III. Different surgical approaches were selected according to the range and positions of the lesions. One case with severe atypical hyperplasia received postoperative radiotherapy.

RESULTSAll cases were followed up for 3-14 years, 7 cases recurred. All occurrence within 2 years after operation. Malignant change and death was found in 1 case. After operation, epiphora occurred in 2 cases, maxillary sinus labiogingival groove fistula occurred in 2 cases, facial numbness occurred in 4 cases and incision hemorrhage occurred in 1 case. All the complications were cured after appropriate treatment.

CONCLUSIONSNaso-endoscopic surgery or combined approach is a safe, effective and microinvasive treatment for patients with maxillary sinus inverted papilloma. Accurate selection of suitable approach according to the range and positions of the lesions and correct management of the base of the tumor are critical to the success of the operation.

Endoscopy ; methods ; Humans ; Lacrimal Apparatus Diseases ; Maxillary Sinus ; surgery ; Maxillary Sinus Neoplasms ; surgery ; Nasal Surgical Procedures ; Neoplasm Recurrence, Local ; Nose ; Nose Neoplasms ; Papilloma, Inverted ; surgery ; Paranasal Sinus Neoplasms ; Postoperative Period ; Retrospective Studies