65 mm Hg and CVP between 10-14 cm H2O. In control group no AHHD was performed. Blood samples and urine specimens were obtained before anesthesia (T1), at the end of operation (T2 ) and 72 h after operation (T3 ) for determination of blood and urinary creatinine (BCr, UCr) , blood sodium (BNa) , urinary sodium (UNa), blood urea nitrogen (BUN) , urinary ?1-microglobulin (?1-MG), urinary albumin, urinary immuno-globulin G, creatinine clearance (CCr), and fractional sodium clearance (FENa) . Results BUN, urinary albumin, urinary immuno-globulin G, CCr and FENa were normal during the study in both groups. Urinary concentration of ?1-MG was significantly increased at T2 as compared with the baseline value before anesthesia (T, ) and declined at T3 but was still significantly higher than that at T1 . There was no significant difference between the two groups in terms of the parameters mentioned above. Conclusion AHHD with 6% HES (200/0.5) has no detrimental effects on renal function in patients with normal function.

Objective To investigate the efficacy of preemptive analgesia with parecoxib sodium combined with local infiltration anesthesia with ropivacaine for postoperative pain after laparoscopic cholecystectomy.Methods One hundred and fifty ASA Ⅰ or Ⅱ patients,aged 41-63 yr,weighing 55-87 kg,scheduled for laparoscopic cholecystectomy under the general anesthesia,were randomly divided into 3 groups (n=50 each): parecoxib sodium+0.9％ normal saline (group A),parecoxib sodium + 0.5％ ropivacaine (group B) and parecoxib sodium + 0.75 ％ ropivacaine (group C).Parecoxib sodium 40 mg was injected intravenously 30 min before induction of anesthesia.Anesthesia was induced and maintained with remifentanil and propofol given by TCI.Immediately before skin closure,0.9％ normal saline 12 ml was given in group A,and 0.5％ and 0.75％ ropivacaine 12 ml were injected for local infiltration anesthesia in groups B and C,respectively.VAS scores were maintained ≤ 3after operation.When VAS scores ＞ 3,pethidine 75 mg was injected intramuscularly.Ramsay sedation scores were recorded at the end of operation and 2,4,8,12 and 24 h after operation.The side effects (nausea and vomiting,allergy,respiratory depression,etc.),requirement for pethidine,algesic sites (incisional pain,upper abdominal pain,referred pain in right shoulder),and condition of the wound healing were all recorded within 24 h after opcration.Results Compared with group A,Ramsay sedation scores,the incidence of nausea and vomiting,the requirement for pethidine and total amount of pethidine,and the incidence of incisional pain were significantly decreased in groups B and C (P ＜ 0.05 or 0.01).Compared with group B,the requirement for pethidine and total amount of pethidine,and the incidence of incisional pain were significantly decreased in group C (P ＜ 0.05 or 0.01).There was no significant difference in Ramsay sedation scores between groups B and C (P ＞ 0.05).There was no significant difference in the condition of the wound healing,upper abdominal pain and referred pain in right shoulder between groups A,B and C (P ＞ 0.05).Conclusion For the patients scheduled for laparoscopic cholecystectomy,local infiltration anesthesia with ropivacaine can improve the efficacy of preemptive analgesia with parecoxib sodium,and it provides better postoperative analgesia when 0.75 ％ ropivacaine is used.

Objective To understand the changes of cardiac systolic and diastolic function in human immunodeficiency virus (HIV)-infected patients without evidence of cardiac disease in China.Methods Forty-two HIV-infected patients who were followed up in the Department of Infectious Diseases at Peking Union Medical College Hospital without cardiac involvement were recruited.All the HIV-infected patients had received highly active antiroviral therapy (HAART) for more than 12 months with viral suppression.And 30 age and sex matched healthy subjects without cardiac disease manifestations were enrolled as controls.Every group members underwent transthoracic echocardiography evaluation.The indexes of cardiac systolic and diastolic function between HIV-infected patients and healthy controls were compared.Results Diastolic abnormality occurred in 20 cases in HIV-infected group and 6 cases in control group, with statistically significant difference (χ2=5.79, P=0.007).The E wave deceleration time (EDT) in HIV-infected patients were significantly decreased than healthy controls ([161.87±21.64] ms vs.[190.34±37.22], t=-3.20, P=0.002).There were no significant differences of E/A ratio ([1.16±0.35] vs.[1.19±0.26]), E/Ea ratio ([5.43±1.99] vs.[5.78±0.91]), isovolumic relaxation time (IVRT), ([93.18±20.34] ms vs.[93.57±18.55]ms), Ea ([10.18±2.80] cm/s vs.[11.45±2.75] cm/s) between HIV-infected patients and controls (t=1.13,1.53,0.67 and 0.29, respectively, all P>0.05).Among cardiac systolic function markers, left ventricular ejection fractions in HIV-infected patients and control group were (66.7±6.4)% and (68.7±4.2)%, respectively.And left ventricular shortening rates were (37.08±4.79)% and (38.17±3.96)%, respectively.Both showed no significant difference between the two groups (t=-1.51 and-1.00, respectively, both P>0.05).Conclusions Compared with control group, subclinical cardiac diastolic dysfunction is more frequently observed in HIV-infected patients.However, there are no significant differences of cardiac systolic function markers between HIV-infected patients and controls.

Objective To analyze the risk factors of pulmonary hypertension in patients with systemic lupus erythematosus (SLE-PH).Methods Echo data of 598 SLE patients were collected,clinical characteristics of 107 suspected SLE-PH (PASP ≥40 mmHg,estimated by Echo) and 64 suspected moderate to severe PH (PASP ≥50 mmHg) were retrospectively analyzed.T-test,x2-test and Logisticregression were used for statistical analysis.Results Out of 598 patients 70.7％(423 patients) had abnormal Echo findings,and pericardial effusion in 45.5％(272 cases),valvular insufficiency in 31.3％(187 cases),suspected PH in 17.9％(107 cases),left ventricular enlargement in 5.9％(35 cases),left ventricular hypertrophy in 4.3％(26cases).In addition 1.7％ had mitral valve prolapse,1.5％ had mitral valve vegetation,and right ventricular enlargement in 6.5％(39 cases),LVEF＜50％ in 6.0％(36 cases),right ventricular systolic dysfunction in 2.2％(13 cases).Logistic regression analysis showed Raynaud's phenomenon (OR=3.205,95％CI:1.911-5.375,P=0.000),thrombocytopenia (OR=1.680,95％CI:1.049-2.689,P=0.031),hyperuricemia (OR=3.643,95％CI:2.154-6.164,P=0.000),and anti-U1RNP antibody positivity (OR=1.777,95％CI:1.099-2.874,P=0.019)were independent risk factors for suspected SLE-PH,fever (OR=0.576,P=0.029)and rash (OR=0.558,P=0.017) were independent protective factors for suspected SLE-PH.SLE duration (OR=1.145,95％CI:1.016-1.290,P=0.026) and Raynaud's phenomenon (OR=3.371,95％CI:1.126-10.086,P=0.030)were independent risk factors for suspected moderate to severe PH,nephritic syndrome (OR=0.042,P=0.009) was the in dependent protective factor for suspected moderate to severe PH.Conclusion Cardiac involvement is common in SLE patients.Screening for PH should be considered in SLE patients with thrombocytopenia,hyperuricemia,anti-U1RNP antibody positivity,particularly with Raynaud's phenomenon.

Objective To investigate the clinical features of gynecological malignant tumor related multiple primary malignant neoplasms (MPMN).Methods Apply retrospective and comprehensive analysis to the clinical data of 30 patients with gynecological malignant tumor related MPMN.Results Synchronous MPMN were found in 9 patients.Their average age was 50.2 years old and their median age was 49 years old.The neoplasms were located at ovary,uterus,cervix,breast and intestine.Metachronous MPMN were found in 21 patients.Their average age was 57.7 and their median age was 57 years old.The median interval between the first and the second primary malignant neoplasm was 4.0 years.The neoplasms were located at breast,ovary,uterus,gastrointestinal tract,uterine cervix,lung etc.In 30 cases,26 of them were treated by surgical operation and further adjunctive treatment of chemotherapy and (or) radiotherapy was conducted as per the neoplasm staging and its pathological results.The rest 4 patients (first primary malignant neoplasms were excised from 3 of them and another one was not treated by surgical operation) received adjunctive treatment of chemotherapy and (or) radiotherapy.Followed ups,which varied from 6 to 60 months,were made to 29 patients and 20 out of the 29 were alive.5-year survival rate of patients with gynecological malignant tumor related MPMN was 47.8％,2-year survival rate was 73.9％,and 1-year survival rate was 88.6％.Conclusion Pay more attention to the patients with gynecological malignant tumor related MPMN,examine the high-risk patients with malignant tumor comprehensively,identify whether it is recurrence,metastasis or new growth of malignant neoplasm,and further ensure early diagnosis and proper treatment,avoiding misdiagnosis and missed diagnosis.

Objective Amyotrophic lateral sclerosis(ALS)is a progressive paralytic disorder resulting from the degeneration of upper and lower motor neurons.Sporadic ALS(SALS)accounm for majority of patients.ALS is a kind of complex disorder.There were several single nucleotide polymorphism (SNP)reported to be associated with SALS in recently published genome-wide association(GWA)study,but there are few data from Asia ALS population and no report focus on SNP which may associated with SALS of Chinese origin.Our study is to screen and add the SNPs related to the risks of SALs in Chinese.Methods Eighty-six individuals with SALS and 94 matched controls were recruited for our study and genomic DNA from blood samples was extracted.Genotypes were determined by a matrix assisted laser desorption/ionization time of flisht mass spectrometry based approach followed by association analysis. Results Individual genotype data for 8 SNPs,rs6700125,rs10260404, rs1942239,rs2279812,rs2405657,rs558889,rs6922711 and rs935 1470 in Chinese population showed no significant association with sporadic ALS.Combining genotype data from published GWA,rs1942239 gained in strength of allelic association(P value decreased to 9.07×10-5 from 1.48×10-4),and rs558889 deviated Hardy-Weinberg equilibrium at ALS case group which may be associated with susceptibility.Conclusions SNP rs1942239 and rs558889 may contribute to susceptibility of sporadic ALS in Chinese patient.The larger sample studies are warranted to confirm the association.

Objective:To investigate the effect of modified transanal approach in the repair of vesicorectal fistula after radical prostatectomy.Methods:From September 2011 to December 2019, 32 cases of vesicorectal fistula after radical prostatectomy were retrospectively analyzed. All patients underwent cystostomy before repair operation. The average diameter of the fistulas was 19 (3-40) mm. There was only one fistula in 24 cases and 8 cases with more than 2 fistulas. The operation was performed in the jack knife position, and the fistula was prepared by resection of the fistula through the anus with bipolar resectoscope. Then bladder wall and rectum wall were separated by the loop and sutured respectively. After operation, the patients were treated with antispasmodic and anti-infective treatment, and the catheter was retained. Cystography and cystoscopy were reexamined 3 months after operation. Catheter was removed in the successful cases, and the failure was repaired again.Results:All operations were completed successfully. The mean operation time was 67(55-125) min, and the median follow-up was 22 (6-30) months. Thirty-one cases (96.8%) were successfully repaired, of which 25 cases were successfully repaired at the first operation, and 6 cases were successfully repaired again (all by transanal route). One case failed to be repaired. He had received external pelvic radiotherapy before operation. After the failure of repair, cystoscopy showed large fistula and stiff surrounding tissue. Then bilateral ureteral skin stoma and cystectomy were performed.Conclusions:Modified transanal approach in the repair of vesicorectal fistula after radical prostatectomy is an effective method. This kind of operation has less trauma, fewer complications and can be operated repeatedly. It is suitable for patients with low position, small fistula and without radiotherapy.

Objective To validate the performance of six enzymatic glycated albumin reagents and evaluate their clinical application.Methods The performance of six enzymatic glycated albumin reagents(labled as A,B,C,D,E,F) from Beijing Jiuqiang Co, Beijing Lideman Co,Ningbomeikang Co, Beijing Haomai Co, Sichuan Maike Co and Asahi Kasei Co were assessed on Olympus AU5800 automatic biochemistry analyzer.According to the standard of CLSI,the precision,interference and linear correlation of these reagents were assessed.To assess the accuracy of GA% ,we used GA standard material whose value had been assigned using ID-LC/MS method provided by ReCCS.To do the method comparison and determine the consistency of assay, 50 fresh serum samples of T2DM outpatient and 80 fresh serum samples of apparently healthy people in Jan 2016 were tested using six kits.According to the EP28-A3C protocol, the reference range for GA%was validated in 122 apparently healthy individuals undertaking medical examination from January to February 2016 in PUMC.Results The precision,and the ability of anti-interference of the six reagents were good.The accuracy percentage deviation of six reagents was-19.3%-9.2%.The correlation coefficient of domestic reagents A to E and imported reagents F in the determination of GA% was 0.966-0.999, the average absolute bias was 7.0%-10.4%.The coincidence rate of A-E and F in determining abnormal GA% was between 88.5% and 96.9%.The coincidence rate was increased after switching to the reference range for preliminary clinical evaluation.Conclusion Six GA enzymatic kits used in automatic biochemical analyzer have high precision and strong anti-interference ability.Accuracy still needs to be improved.

Objective? To investigate the effect of intervention theory based on timing theory on self-management behavior and medication compliance of patients with percutaneous coronary intervention (PCI). Methods? A total of 126 patients who underwent PCI in People＇s Hospital of He＇nan Province in 2018 were enrolled, including 67 who had PCI from April to June in 2018 in the experimental group and 59 who had PCI from January to March in 2018 in the control group. Patients in the control group received routine nursing intervention. The patients in the experimental group were treated with an intervention program based on timing theory. The Coronary Heart Disease Self-Management Scale and the Morisky Medication Adherence Questionnaire were used to compare the effects of the intervention. Results? After intervention, the scores of "daily life management(17.11±3.62)", "bad habit management(16.33±4.36)", "disease knowledge management(17.11±3.68)", "symptom management(14.25±4.15)", "first aid management(13.55±4.27)","treatment compliance management(11.13±3.62)" and "emotional cognitive management(15.69±4.25)" in the experimental group were higher than the control group with(14.57±3.69),(14.17±3.88),(14.36±3.56), (12.34±4.46),(10.41±3.89),(7.69±4.14),(13.23±4.32)respectively, and the differences were statistically significant (t=3.895, 2.921, 4.250, 2.489, 4.293, 4.976,3.217;P＜0.05). After the intervention, the scores of the medication adherence questionnaire in the experimental group was (6.35±1.12), and the control group was (5.92±1.17). The difference between the two groups was statistically significant (t=2.106, P=0.037). Conclusions? Timing theory can improve the self-management behavior and medication compliance of PCI patients, and can be applied in clinical practice.

BACKGROUND:The Twin-block orthodontic appliance is commonly used for the correction of Class Ⅱ malocclusion.Its mechanism of action in stimulating mandibular growth has been confirmed in many studies,but its impact on maxillary growth is not very clear. OBJECTIVE:By establishing a finite element model to analyze the stress distribution of the maxillary complex,surrounding bone sutures,and maxillary dentition in patients with Class Ⅱ malocclusion wearing Twin-block orthodontic appliances. METHODS:One patient with Class Ⅱ malocclusion who underwent orthodontic treatment at Qingdao Hospital/Qingdao Municipal Hospital of Shandong Rehabilitation University was selected.The bite force data of the patient when wearing the Twin-block orthodontic appliance was measured,and CBCT data were collected.A finite element model was established,including the maxillary complex,peripheral sutures,Twin-block orthodontic appliance,and maxillary dentition.ABAQUS software was used to simulate the stress distribution in the maxilla and maxillary dentition when the patient was wearing the Twin-block appliance. RESULTS AND CONCLUSION:The equivalent stress on the maxillary anterior teeth was significantly smaller than that on the posterior teeth,and the maximum equivalent stress on both sides of the teeth were 4.797 5 Mpa and 8.716 1 Mpa,respectively,which were located at the first premolar.The maximum displacements were presented at the maxillary incisors on both sides of the teeth,which were 0.080 5 mm and 0.081 0 mm,respectively.The maximum equivalent stress on the bone suture was 1.284 Mpa,which was mainly concentrated in the pterygopalatine suture and the frontal-maxillary suture on both sides,and there was almost no difference in the force of the rest of bone sutures;the maximum displacement of the bone suture was 0.07 mm,with the pterygopalatine suture having the largest displacement,followed by the frontal-maxillary suture.The maximal equivalent stress on the maxillary complex was 27.18 Mpa,which was mainly concentrated on both sides of the anterior pyriform foramen of the maxilla,around the nasofrontal suture and around the pterygopalatine suture at the posterior part of the jaws.The maximal displacement of the maxilla was 0.07 mm,which was mainly concentrated on the maxillary alveolar bone.All these findings show that the occlusal force acts on the maxillary complex through the Twin-block appliance,resulting in clockwise rotation of the maxilla and steepening of the dentition plane.Measures should be taken to compensate for this tendency,for example,by considering maxillary molar elongation and intrusion in the process of occlusion,which are not only able to flatten the occlusal plane,but facilitate the mandibular protraction,thereby further improving Class Ⅱ malocclusion orthodontic treatment.