Objective To evaluate the feasibility of using stroke volume variation (SVV) as the left ventricular preload to draw the cardiac function curve.Methods Twenty-seven patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅱ (New York Heart Association Ⅱ),with abnormal cardiac function,scheduled for elective offpany coronary artery byp grafting,were enrolled in this study.Twenty-five patients,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ (New York Heart Association Ⅰ),with normal cardiac function,scheduled for elective non-cardiac surgery,were also enrolled in this study.SVV and SV were monitored by using a FloTrac/VigileoTM system.The patients were in the supine position from the end of anesthesia induction to the beginning of surgery.After the hemodynamics was kept stable for 5 min,SVV and SV were recorded.6％ hydroxyethyl starch 130/0.4 500 ml was intravenously infused over 20 min.SVV and SV were recorded after volume expansion.Spearman rank-order correlation was used to analyze the relationship between SVV and SV.The quadratic regression analysis was used to draw the SVV-SV curve,and the SVV-SV curve was compared with the Frank-Starling curve.Results Compared with the value before volume expansion,SVV and HR were significantly decreased,and SV was increased after volume expansion in the patients with normal cardiac function,and SVV was decreased after volume expansion in the patients with abnormal cardiac function (P＜0.01).SVV was negatively correlated with SV in the patients with normal cardiac function,and r=-0.467 (P＜0.05).SVV was negatively correlated with SV in the patients with abnormal cardiac function,and r=-0.378 (P＜0.05).The mirror symmetry was found between the SVV-SV curve in the patients with normal cardiac function and the normal Frank-Starling curve,and the general trend was close.The symmetry was not detected between the SVV-SV curve in the patients with abnormal cardiac function and the Frank-Starling curve in the patients with decreased myocardial contractility,and the general trend was not close.Conclusion For the patients with normal cardiac function,SVV can be used as the left ventricular preload to draw the cardiac function curve.

Long-term treatment with an agonist of peroxisome proliferator-activated receptor (PPAR)-γ is associated with bone fractures in the clinical practice. However, the mechanisms underlying the fractures are not fully understood. This study was aimed to examine the effect of rosiglitazone (an agonist of PPAR-γ) of different doses on the proliferation, differentiation, and transforming growth factor beta 1 (TGF-β1)-induced expression of connective tissue growth factor (CTGF) in primary rat osteoblasts in vitro. Osteoblasts were isolated from newly born SD rats and treated with different doses of rosiglitazone (0-20 μmol/L). The proliferation and differentiation of osteoblasts were measured by MTT assay and NPP assay, respectively. The expression of CTGF was determined by RT-PCR and Western blotting. The results showed that most isolated osteoblasts displayed strong alkaline phosphatase (ALP) activity and treatment with different doses of rosiglitazone did not affect their proliferation, but significantly inhibited the differentiation of osteoblasts in a dose-dependent manner. Moreover, treatment with different doses of rosiglitazone significantly reduced the TGF-β1-induced CTGF mRNA transcription and protein expression in a dose-dependent manner in rat osteoblasts. It was concluded that the activation of PPAR-γ may inhibit the differentiation of osteoblasts by reducing the TGF-β1-induced CTGF expression in vitro.

Objective To observe the clinical efficacy of Xuanfeitongfu method in treatment of severe pneumonia and to explore its clinical value in the management of severe pneumonia. Methods Totally,62 patients with severe pneumonia were randomly divided into the control group (n = 30) and the treatment group (n = 32). The control group was given cluster treatment,including oxygen cure,anti-infection and nutrition support and maintaining a stable internal environment and etc. The treatment group was treated with Tongfu decoction orally(one dose a day,a total of 5 days)on a basis of cluster treatment. The comparison was conducted in the 2 groups in the levels of C reaction protein,calcitonin,the change of blood gas analysis,the time of mechanical ventilation and the mortality of severe pneumonia in ICU at baseline and 3,5 days after treatment. Results The level of C-reactive protein,calcitonin,the change of blood gas analysis were statistically significant (P < 0.05). The time of mechanical ventilation and the mortality were better in the treatment group (P < 0.05). Conclusion Xuanfeitongfu method can effectively improve oxygenation ,assist the anti-infection effect ,reduce the time of mechanical ventilation and ICU retention time ,ultimately improve the outcome of severe pneumonia.

In order to improve the teaching reform of higher education systematically and op-erably, and in order to improve the effectiveness of teaching reform, teaching reform in Higher Educa-tion in the micro system engineering and SIMPP analysis method were proposed. With questionnaire survey on classroom learning state of all students from traditional Chinese medicine Grade 2010-2013 of Beijing University as an example, the principle and operation steps of SIMPP analysis method was systematically discussed. According to the students' related behavior pattern and strategy analysis affected by teachers, the analysis of the results of interpretation method and application direction was illustrated. At the same time, through the monograph, nine aspects (academic diligence level, learning effectiveness of self cognition, learning interest, teacher's influence, self-study ability, class atten-dance, learning objectives, curriculum satisfaction, major satisfaction) were analyzed by SIMPP. By modeling the related factors and their relationship, the internal relations between different factors were cleared, and the students' behavior patterns were found, and the corresponding reform measures were designed. Research shows that the concept and methods of teaching reform in Higher Education in the micro system engineering will produce a positive impact on teaching reform, curriculum reform, and the integration of family education and school education.

Objective To investigate the pathological diagnosis of high-grade intraepithelial neoplasia in gastric biopsy.MethodsOne hundred and forty-three cases diagnosed by gastric biopsy as high-grade intraepithelial neoplasia were analyzed by light microscopy,and were compared with the pathological findings of surgical specimens in 60 cases and a second biopsy in 13 cases.Results Among the sixty cases treated surgically following the gastric biopsies,no carcinoma was found in 6,while the other 54 were diagnosed as gastric adenocarcinoma,27 in advanced stage and 27 in early stage,respectively.Fifteen cases were well-differentiated,24 moderately-differentiated,12 poorly-differentiated and 3 were of mucinous type.Four of the 13 cases with a second biopsy were diagnosed as well-differentiated adenocarcinoma,8 low-grade intraepithelial neoplasia and 1 chronic inflammation.The colorectal adenomas-like changes were morphologically found in 6 surgically-treated cases without carcinoma,5 of whom mucous muscles were not found by biopsy.Fibroblastic reactions were found in 9 cases,all of which were diagnosed as adenocarcinoma in surgical specimens.Conclusion Ninety percent of the cases who are diagnosed as high-grade intraepithelial neoplasia by biopsy may have already been complicated with adenocarcinoma.The location and depth of the specimen in gastric biopsy have a considerable influence on pathological diagnosis.The fibroblastic reaction may be considered as an important marker for gastric adenocarcinoma in pathological diagnosis of gastric biopsy.

Objective Build the hospital scientific research management platform.Methods According to expenditure process and the management standard requirements,the establishment of a fund management system platform to achieve budget、accounted for,spending and audit feedback function.Results Scientific research funds management platform is mainly composed of project application,project establishment and review,the report query and remittance receipt of financial department.Full consideration of the personnel,project,financial and other related system interface.In the construction of data using the standards of the state and the university scientific research information.Conclusions Through building the hospital scientific research management platform,improving the working efficiency,reducing the labor intensity of the management and financial personnel,realizing the accuracy and effectiveness of management.

Objective To summarize the experience of intraoperative rapid parathyroid hormone (PTH) detection by immunochromatography in thyroid surgery.Methods Patients undergoing thyroid surgery in Shanghai Tenth People's Hospital from Nov.2016 to Jul.2017 were collected and the clinical data including level of blood calcium,serum phosphorus and PTH,and pathological findings were analyzed.Results In this study,im munochromatographic assay was used in 45 cases (experimental group) and nano carbon method was used in 47 cases (control group).In benign cases,levels of blood calcium and PTH in experimental group were higher than those in the control group ((2.07±0.09) vs (2.04±0.06) and (3.41±1.82) vs (3.34±1.84),P＞0.05).In malignant cases,blood calcium level in experimental group was higher than that in the control group ((2.02±0.13) vs (1.99±0.38),P＞0.05) and PTH level was significantly higher than that in the control group ((2.22±1.27) vs (1.44±1.44),P＜0.05).Serum phosphorus level in experimental group group was much lower than that in the control group ((1.02±0.17) vs (1.14±0.23),P＜0.05).Conclusions Using intraoperative rapid PTH detection by immunochromatography can identify parathyroid and avoid accidental injury of parathyroid gland,which can reduce the postoperative incidence of hypocalcemia.

Objective To assess the changes in heart geometry and function during off-pump coronary artery bypass grafting(CABG).Methods Thirty ASAⅡorⅢpatients(24 males,6 females)aged 50-78 undergoing elective off-pump CABG were studied.After induction of anesthesia and tracheal intubation a catheter which was connected to the monitor measuring continuous cardiac output(CCO),mixed venous blood oxygen saturation(S(?)O_2)and CEDV was placed via right internal jugular vein and the probe of multi-phase transesophageal echocardiograph(TEE)(Sonos HP 2500)was inserted in the esophagus.The distance between the probe and the incisors was between 34-45 cm.The hemodynamic variables and TEE parameters were recorded when epicardium was opened(T_1,baseline)when the octopus tissue stabilizer was placed during anastomosis between the graft vessel and left anterior descending artery(LAD)(T_2)left circumflex artery(LCX)(T_3)and right coronary artery(RCA)(T_4)and when the anastomoses between the vessel grafts and aorta was completed (T_5).Results At T_2 the mitral valve deceleration time(DT_1)and the blood flow through the mitral valve(Q_1) were decreased significantly as compared with the baseline(T_1);MAP was significantly decreased while HR and CVP were increased(P＜0.05).At T_3 the left and right ventricular end-diastolic diameter(LVEDD,RVEDD), tricuspid valve diameter(TVD)and the blood flow through Q_1 and tricuspid valve(Q_2)were significantly decreased as compared to the baseline values at T_1.The mitral valve E/A ratio was increased while the tricuspid valve E/A ratio was decreased(P＜0.05).The MAP,S(?)O_2,right ventricular end-systolic and end-diastolic volume(RVESV,RVEDV)and right ventricular ejection fraction were significantly decreased while HR and CVP were increased at T_3 as compared to the baseline at T_1.At T_4 LVESD,LVEDD,MVD,tricuspid valve E/A ratio and Q_1 were significantly decreased as compared to the baseline at T_1(P＜0.05).MAP,MPAP,SV,S(?)O_2, RVEF,RVESV and RVEDV were significantly decreased while HR and CVP were increased(P＜0.05).At T_5 all the TEE and hemodynamic parameters returned to the baseline valves at T_1.Conclusion During anastomoses between graft vessels and LAD,LCX and RCA,both left and right ventricles are compared to some extent and the heart function is impaired temporarily but returns to the baseline after the anastomoses are completed.

In this cross-sectional survey,2 682 traffic policemen in Tianjin were enrolled,and they were tested with Occupational Stress Inventory-Revised (OSI-R) and Symptom Checklist 90 (SCL-90).Body mass index,blood pressure,fasting blood glucose,triglycerides,and high-density lipoprotein-cholesterol ( HDL-C ) were also determined at the same time. Correlation analysis showed that body mass index was positively correlated with somatization ( r =0.039,P =0.045 ),hostility ( r =0.046,P =0.01 8 ),and psychoticism ( r =0.041,P =0.036).Systolic blood pressure was positively correlated to somatization (r =0.056,P =0.004 ),obsessive-compulsiveness ( r =0.044,P =0.023 ),interpersonal sensitivity ( r =0.041,P =0.034 ),depression ( r =0.039,P =0.043),anxiety ( r =0.055,P =0.004 ),and psychoticism ( r =0.051,P =0.009 ).Diastolic blood pressure was positively correlated to somatization ( r =0.047,P =0.015 ),interpersonal sensitivity ( r =0.042,P =0.030 ),anxiety ( r =0.050,P =0.010 ),and psychoticism ( r =0.047,P =0.014 ).Fasting blood glucose was positively correlated to somatization ( r=0.042,P=0.028 ).Multiple regression analysis showed that occupational stress factors were role boundary,physical environment,responsibility,recreation,role ambiguity,role overload,and cognitive coping.Among these factors,role ambiguity and cognitive coping reduced occupational stress while others increased the stress.The results of the unconditional logistical regression analysis showed that there is an independent association of metabolic syndrome with somatization,role insufficiency,and physical strain for the task and body tension ( P＜0.01).

Objectives To report a generalized atrophic benign epidermolysis bullosa family,identify the deficient protein and related pathogenic gene mutation. Methods The diagnosis was confirmed based on clinical manifestations and necessary examinations. Electron microscopy and immunofluorescent staining were used to detect the deficient protein. The pathogenic gene mutation was identified by PCR amplification of ge-nomic DNA with primers targeting the flanking introns, followed by direct automated sequencing. Results In the family, the affected individuals were homozygous for a novel 4-bp deletion in COL17A1, 3897delATCT, which resulted in a downstream premature termination codon. Conclusions 3897delATCT of COL17A1 is the pathogenic gene mutation in the patients and probably results in nonsense-mediated mRNA decay and abrogation of type XⅦ collagen synthesis, as documented in the literature.