Objective:To explore the diagnostic value of dynamic electrocardiogram (DCG ) in syncope patients . Methods :A total of 148 inpatients and outpatients ,who were diagnosed as syncope in our hospital from 2010 to 2013 ,received 24h DCG examination .Results:Among the 148 patients ,there were 94 cases (63.5% ) with abnor‐mal DCG ,40 cases (27.0% ) occurred syncope during monitoring ,25 cases (16.9% ) occurred syncope‐related ar‐rhythmias ,another one case manifested as atrial fibrillation with rapid ventricular rate during monitoring but didn't appear syncope‐related symptoms such as dizziness and amaurosis etc .,15 patients (10.1% ) occurred syncope‐relat‐ed symptoms during monitoring ,but DCG examination didn't find arrhythmias .Conclusion:Dynamic electrocardio‐gram examination can find syncope‐related arrhythmias ,then they may receive related therapeutic measures for im‐proving prognosis .

Objective To observe the clinical features and outcomes of vitrectomy for diabetic retinopathy (DR) with central retinal vein occlusion (CRVO) in type 2 diabetes mellitus (T2DM).Methods A total of 192 patients (241 eyes) with proliferative DR (PDR) who underwent vitrectomy were enrolled in this study.All the patients were diagnosed as vitreous hemorrhage (VH) because of suddenly decreased vision.There were 93 eyes with tractional retinal detachment (TRD) and six eyes with neovascularization of iris (NVI).The patients were divided into PDR with CRVO group (group A,41 eyes) and PDR group (group B,200 eyes) according to the results of fundus examination.All patients received vitrectomy with silicone oil and C3F8 gas tamponade.There were 138 eyes with silicone oil tamponade which including 30 eyes in group A and 108 eyes in group B.The difference of number in silicone oil-filled eyes in two groups was statistically significant (x2=5.110,P＜0.05).There were 38 eyes with C3F8 gas tamponade which including six eyes in group A and 32 eyes in group B.There was no difference in C3F8 gas-filled eyes numbers in two groups (x2 =0.048,P＞0.05).The follow-up ranged from one to 60 months,with the mean of (28.69± 17.28) months.The corrected vision,retinal reattachment,persisting macular edema (ME),neovascular glaucoma (NVG) and repeated VH after surgery were comparatively analyzed.Results Of 241 eyes,there were 41 eyes (17.0％) with CRVO.Before surgery,the differences of corrected vision (Z=-0.138),intraocular pressure (t=0.966),whether there was TRDor not (x2=0.412),whether underwent panretinal photocoagulation or not (x2 =1.416) were not statistically significant (P＞0.05),but the difference of whether NVI were present or not was statistically significant (x2=31.724,P＜0.05)between two groups.After surgery,the corrected vision improved in both two groups (Z=2.319,4.589;P＜0.05).There was no difference of corrected vision after surgery between two groups (Z=0.782,P＞0.05).Postoperative complications occurred in 94 eyes,including 26 eyes in group A and 68 eyes in group B.The differences of incidence of reoperation (x2 =0.498),retinal reattachment (x2 =0.818),persisting ME (x2 =2.722) between two groups after surgery were not statistically significant (P ＞ 0.05).The incidence of repeated VH (x2 =5.737) and NVG (x2 =6.604) in group A were higher than those in group B (P＜ 0.05).Conclusions CRVO is commonly found to coexist with DR in T2DM patients with VH.Combined with CRVO patients are more likely to suffer NVI.Vitrectomy can improve the visual function in PDR with CRVO patients.

Objective To develop and charaterize a series of Poloxamer-and Carbopol-based in situ gel for ophthalmic use as to enhance the ability of drug to retain in eyes and delay drug release.Methods The gel was prepared using Poloxamer 407/188 and Carbopol 974P as gelling agent and viscosity enhancer,respectively.Rheological characteristics were evaluated and behaviour of drug release in vitro was investigated by modified Franz diffusion cells.Results The rheological study indicated that the gel was physically entangled polymer solutions at 20 ℃ and then converted into a network structure with secondary bonds at 35 ℃.The gel released the drug molecules slowly in 4 h.The best fit model was Higuchi matrix model(r=0.992 3).Formulations consisting of Poloxamer 188 and Carbopol 974P were proved to be able to decrease the drug release speed efficiently.The impact on elastic modulus G" of the gel caused by those two were different.Conclusion An in situ gel with suitable sol-gel transition temperature and satisfactory release pattern could be achieved by adjusting the ratio of Poloxamer 407 to Poloxamer 188.The developed formulations have the ability to prolong the ocular residence time,which suggests it may be a new durg delivery system with bright future.

Objective To evaluate the clinical results of a combination of lateral buttress plate and medical antiglide plate internal fixation for biocondylar tibia plateau fractures. Methods A total of 26 biocondylar tibia plateau fractures belonged to type Ⅴ and type Ⅵ according to Schatzker classification and treated with open reduction. Lateral buttress plate and medical antiglide plate were applied for limited internal fixation. The follow up continued till fracture healing to observe if there existed bone dislocation and determine the range of knee motion and Iowa knee score. Results No obvious shift of fragment was found in 26 cases with mean range of knee motion for 92? and mean Iowa knee score for 93 points. Conclusion Combination of lateral buttress plate and medical antiglide plate is a good method for internal fixation of biocondylar tibia plateau fractures,but the conclusion needs large number of clinical verifications.

Objective To investigate the efficacy and safety of percutaneous microwave ablation in the treatment of hypersplenism.Methods From March 2007 to May 2011,38 patients with hepatitis B virus caused liver cirrhosis and complicated with hypersplenism received percutaneous microwave ablation treatment for several times.Before percutaneous microwave ablation treatment,the volume of spleen was calculated according to 3D computed tomography (CT) scan.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were also tested.For the first time,1/3 volume of spleen was ablated.If no complication were observed in one week after ablation,then another 1/3 volume of spleen was ablated.Blood routine and liver function test were checked on the 1st,3rd and 5th day after microwave ablation.Blood routine,liver function test and ultrasound were examined on 7th and 14th day after microwave ablation.On the 30th day CT examination was conducted.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were detected at one month,three month and every three month after microwave ablation.The follow up duration was over two years.The t-test was performed for clinical data comparison.Results The mean ratio of ablated spleen was (47 ±5)％ (range 41％ to 57％).Preoperative white blood cell count was (2.46±0.78)× 109/L,which gradually increased after operation and peaked on the 3rd day after operation ((5.34 ± 2.10) × 109/L).Then gradually decreased,which was (3.16 ± 1.02) × 109/L at 24 month and the difference was statistically significant compared with that of preoperation (t=-3.349,P＜0.01).Preoperative platelet count was (46.58 ± 17.30) × 109/L,which gradually decreased after operation and was lowest on the 3rd day after operation.Then gradually increased,which peaked at 30 days after operation ((101.79 ± 25.80) × 109/L) and then gradually decreased,which was (61.97 ± 15.09) × 109/L at 24 month and the difference was statistically significant compared with that of preoperation (t＝-4.135,P＜0.01).The inner diameter of portal vein was (14.66±0.88) mm preoperation,which was (13.22±0.64) mm at three month after operation and the difference was statistically significant compared with that of preoperation (t=8.145,P＜0.01).It was (14.64±0.81) mm at six month after operation and the difference was not statistically significant compared with that of preoperation (P＞ 0.05).The major adverse effects were fever,left upper abdominal pain,left shoulder pain,pleural effusion,intraperitoneal hemorrhage and temporary hemoglobinuria which all recovered after symptomatic treatment.No severe complication such as uncontrollable bleeding,splenic abscess,spleen rupture and the surrounding organ injury and treatment related death were observed.Conclusion Percutaneous microwave ablation for several times could safely destroy suitable volume of spleen,increase platelet and white blood cell count,improve portal hypertension and with rare complications,which might be a minimally invasive techniques with clinical application value in the treatment of the hypersplenism.

The fermentation conditions of alkaline lipase producing by Pseudomonas cepacia PCL-3 were optimized.Based on the analysis of single factorial experiments,dextrin was the most suitable carbon source,peptone and urea were the suitable compound nitrogen sources among the examined materials.Three significant factors(urea,inoculum and initial pH) were selected from the eight factors related to lipase production by Plaekett-Burman method,and were further optimized with response surface analysis.And then,steepest ascent procedures were applied to define the optimal response region of the three factors.The obtained optimal conditions were urea 0.15%,inoculum 3.05% and initial pH 8.38,under which conditions,the enzyme activity was improved from 25.37 U/ml to 48.88 U/ml,enhanced 1.93 folds.Starting from the flask conditions,the highest lipase activity of 47.69U/ml was achieved by batch fermentation in a 10 L fermentor after 52 h of the cultivation.

Objective To evaluate the effect of dexmedetomidine on acute kidney injury after cardiac valve replacement with cardiopulmonary bypass (CPB).Methods One hundred patients of both sexes with rheumatic heart disease,aged 32-64 yr,weighing 46-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =50 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was intravenously infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation in group D,while the equal volume of normal saline was given in group C.The urine output per hour during the postoperative 48 h period was recorded.At 6,12,24,36 and 48 h after operation,blood samples were collected from the median cubital vein for determination of serum creatinine levels.The development and severity of acute kidney injury were determined according to the urine output and serum creatinine level.Results Compared with group C,the incidence and severity of acute kidney injury were significantly decreased in the postoperative 48 h period in group D (P＜0.05).Conclusion Dexmedetomidine infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation can reduce the development and severity of acute kidney injury after cardiac valve replacement with CPB in patients.

Objective To investigate the role of the QQ group follow up of nursing education on patients with nasopharyngeal carcinoma after radiotherapy in patients after they discharged. Methods Thirty patients with nasopharyngeal carcinoma hospitalized from January to December 2013 in our department were set as control group and another 30 patients with NPC hospitalized from January to December 2014 in our department were assined to in the experiment group. Patients of two group received health education before discharge . The controls were followed up on phone and the experimental group received QQ group follow up of education for one year, besides phone follow-up. The two groups were compared in terms of incidence of adverse reactions one year after discharge. Results One year after discharge , the incidences of side effects in the experiment group were lowered than those in the control group , and the differences were siguificant difference ( all P < 0 . 05 ) . Conclusion The QQ group follow up of nursing education can reduce the incidence of adverse reactions by radiotherapy after discharge.

Objective To investigate the clinical curative effect of absorbable screw in the treatment of Limbs joint fracture. Methods From May 2009 to May 2011, 86 patients of Limbs joint fracture in our hospital were randomly divided into the observation group and the control group. The observation group were treated with absorbable screw while the control group were given conventional treatment methods of fracture treatment, and the clinical effect of the two groups were observed after treatment. Results The excellent rate was 56. 3% in control group and 96. 3% in observation group. The excellent rate of the clinical treatment in the observation group was significantly better than the control group with a statistically significant difference (P<0. 05). Conclusion The clinical efficacy of absorbable screw for limbs joint frac-ture is significant, and its operation safety is higher. It improves the life quality of patients and it is worth of clinical promotion.

Because of the population aging,the increase of the stroke patients and the need for rehabilitation,the treatment only in the rehabilitation department of the hospital is far from the satisfaction of people's demands of the service of rehabilitation.It is important to extend the community-based rehabilitation.Compared with the rehabilitation in hospitals,it is more economy,efficiency and convenience for stroke patients in community-based rehabilitation services,and further improve the rehabilitation effect of stroke patients.